Many times in these disasters it’s not only the direct effects of the disaster, but the indirect end of the disasters that relates to people’s chronic medical conditions that requires urgent care. How do you create a system to take care of people that, if you’re timely enough or provide the right intervention, keeps them out of the emergency department, keeps them out of the hospital, and out of the ICU?

RM: As you pointed out, the vast majority of resources are private, and yet this is a federal vision. What incentives do you see are important to ensure that private resources come together to support that vision?

RK: I think you touched on the idea that it’s a federal vision, but I think what we’re trying to do is a national vision, [building regionally into a national program]. I think your point is the right one. We’d like to create public-private partnerships. One of the things that the federal government has is a little bit of money—$250 million is a drop in the bucket in a $3 trillion industry. We understand that direct grants are not going to tip people over to join this endeavor. I think in some ways we look at the opportunity for CMS reimbursement to provide some marginal, incremental, above-the-top-line repayment as one possible strategy. There could be other tax incentives that could be identified. I think that’s part of the conversation we need to have with not only your association, but also with the hospital CEOs and others, such as health care insurers, to see what would make sense, because it’s not going to be one thing. As you pointed out, the health care system is diverse by definition, and in some ways you’re going to have to find different things that appeal to different parts of that system to participate and collaborate.

RM: One of the challenges has been that in the local markets, a lot of the health systems compete. Perhaps funding for some sort of care coordination center that’s used on a daily basis may be something that can then be the infrastructure that allows them to collaborate and coordinate when a bigger event occurs.

RK: I think that’s the basis or the logic that has been developed for the health care coalitions. You could say that we’ve not resourced it enough, and I won’t disagree. I think building something that has utility every day and that can expand to meet the extraordinary circumstances of a disaster of some sort, is the best way to make it. I think to build a parallel system, something separate, just break glass when something happens, is really not going to provide the benefit or is worth the investment that we need to make.

RM: You have really reached out and engaged a lot of different organizations, and I was very impressed with that. Are there any final comments you’d like to make to our colleagues about how they can help you move this vision forward?

RK: Well, I think first of all, we welcome their feedback and involvement. I think we’re better off, we’re more informed, we’re more capable, and we’ll have more likelihood of success if we work effectively with your organization as well as others to host those kinds of conversations to help define the vision together. My intent is to be somewhat of a catalyst for this all. We don’t have all the answers in Washington. The key is to ensure that, however we move forward, we move forward together with the commitment that in the end, we’ll not only be able to take care of patients better every day, but on the worst day for America or in a particular community or region, that we can provide the best care for all Americans.