Director, The Dartmouth Institute for Health Policy & Clinical Practice
Solving healthcare's greatest riddle: improving quality while managing costs.
Elliott Fisher is one of the premier thinkers on improving quality while managing costs, as well as the challenges and opportunities ahead for the American healthcare system. A key figure behind accountable care organisations (ACOs), an important component of healthcare reform, Dr. Fisher is a leading developer of new models of healthcare delivery and payment. He believes that performance measurement, accountability, well-implemented technology, empowered patients, and new partnerships will all play a role in moving healthcare forward.
Accountable care organisations (ACOs) — in which a group of providers is directly held accountable for the total cost and quality of care for an attributed patient population — have emerged as a central feature in the changing face of healthcare; 52 percent of Americans are now estimated to live in an area served by an ACO. Dr. Fisher's current research focuses on exploring the determinants of successful ACO formation and performance. He also co-directs the Brookings–Dartmouth ACO Learning Network, in which organisations across the United States contribute to share best practices for ACO implementation.
Elliott's earlier research focused on the causes and consequences of variations in health system spending and performance. His findings indicated that higher spending does not mean higher-quality care: rather, it often means overuse of discretionary services, such as more frequent use of the hospital, specialist referrals, and diagnostic tests, which do not necessarily lead to better quality or health outcomes. On Elliott's analysis, up to 30% of US health care spending is wasted on potentially avoidable care.
Dr. Fisher is the Director of the Dartmouth Institute for Health Policy and Clinical Practice. He is also the John E Wennberg Distinguished Professor of Health Policy, Medicine and Community and Family Medicine at the Geisel School of Medicine at Dartmouth and Co-Director of the Dartmouth Atlas of Healthcare.
He is the author of over 150 research articles and commentaries, and a member of the Institute of Medicine of the National Academy of Sciences.
Eliot tailors each presentation to the needs of his audience and is not limited to the topics we have listed below. These are subjects that have proven valuable to customers in the past and are meant only to suggest his range and interests. Please ask us about any subject that interests you; we are sure that we can accommodate you.
In each of these presentations, Dr. Fisher will describe why the U.S. health care system is under such stress — and why the transition to new payment and delivery models is inevitable. He will then review the origins and evidence underlying each of the emerging new payment models, including bundled payments, the patient centered medical home, and accountable care organizations (ACOs), a policy initiative that he helped design and incorporate in the Affordable Care Act. He will then discuss the implications of current trends in payment and delivery reform for each of the major stakeholders (if a general audience), or more narrowly, for specific audiences. As follows:
For physicians/providers: The transition to new payment and delivery models represents a threat to old ways of working and thinking – and an opportunity to realign clinicians’ work with the values that brought us to medicine. Under new payment models, physicians are taking responsibility not only for ensuring the best possible care for each patient they see, but also for ensuring that all patients in their practice or system with a given condition – such as diabetes, heart failure or cystic fibrosis – receive the best care possible. Achieving high levels of performance under new payment models requires not only new technical skills (such as use of registries, quality improvement, and care coordination), but also new leadership skills (negotiation and managing organisational change). The talk will include an overview of the current status of ACO implementation; specific examples of how provider groups working under new payment models have both improved care and lowered costs; and how moving down this path offers physicians, nurses and other health professionals an opportunity to reconnect with the values that brought them to health care.
For health system executives: The transition to new payment and delivery models represents a serious threat to current institutional goals and practices. While the challenges are substantial, health system leaders need to prepare for the transition – and begin to put in place the capabilities that will be needed to survive (or thrive) in new payment environments. These range from the adaptive leadership skills of change management, physician engagement and collaboration across institutional boundaries to the technical skills of establishing information systems capable of population management, identifying and effectively managing high cost, high need patients, and implementing modern quality improvement methods to both reduce costs and improve care. The talk will include an overview of the current status of ACO implementation; specific examples of how high performing systems are both improving care and lowering costs; and how moving down this path offers the opportunity to realign the daily work of health care with the values underlying the health professions.
For insurance, pharma and device manufacturing executives: Threat and opportunity. The transition to new payment and delivery models represents a serious threat to current business models. Many fear that the various approaches to value-based payment – from episode-based payments to Accountable Care Organizations will either eliminate their role in the health care market place (health plans, for example) or will sharply reduce their market share as pressure to reduce costs increase (pharmaceutical and device manufacturers). In this presentation, Dr. Fisher will describe the origins of the ACO model, the current status of ACO implementation (which is emerging as a partnership between health plans and providers); and the remarkably diverse ways in which it is playing out in the current U.S. market – and elsewhere. He will describe how various sectors – ranging from health plans to device manufacturers – can succeed in this changing environment.
While health care reform has expanded insurance coverage and new payment models offer promise, many challenges remain: some providers are taking advantage of market power to raise prices; the prevalence of obesity and chronic conditions continues to rise; and the important environmental, social, behavioural and economic determinants of future health remain unaddressed. The ReThink Health initiative builds on the work of 2009 Nobel Prize winner Elinor Ostrom, who demonstrated that when properly organized and structured, stakeholders have come together to effectively address complex social problems (ranging from preserving local pastures or fisheries to solving region-wide water use issues). Dr. Fisher will describe the ReThink Health initiative, which is now active in several regions of the US and is intended to complement and leverage ongoing delivery and payment system reforms through three mechanisms: (1) active stewardship – building local community-based backbone organisations that works to align activities to maximise collective impact; (2) effective strategy – drawing on an advanced, evidence based simulation model to help guide the selection and timing of initiatives to achieve impact; and (3) sustainable finance – working with national, state and local payers and policy makers to align financing approaches to ensure sustainability of health care systems and support for community-based interventions.
For nearly 20 years, The Dartmouth Atlas of Health Care has documented remarkable variations in clinical practice and health care spending across the United States – with greater than five fold differences in rates of common surgical procedures and two-fold differences in mortality rates and per-capita spending. The research demonstrating that higher spending or greater utilisation rates were not associated with better quality or outcomes not only helped motivate health care reform, but also provided the insights about what principles should guide reform: (1) ensuring that when the evidence about benefit is unequivocal, health systems should achieve high levels of reliability in delivering these evidence-based services (doing the right thing right); (2) ensuring that when tradeoffs are involved (as in most clinical decisions), patients’ well-informed preferences must guide treatment choices (doing the right thing for the right patient); (3) ensuring that payment and delivery models are aligned to enable providers to improve care and lower costs (doing the right thing, and no more). Dr. Fisher is one of the founders of the Dartmouth Atlas and remains active in its leadership. Insights from this presentation will be useful to clinicians, health system leaders and others interested in advancing their understanding of the remarkable opportunities to improve the performance of health systems in the US and across the globe.
Accountable Care — It's All About the Relationships
The Overtested American | Aspen Institute
A network of private, non-profit hospitals providing health care services:
Dr. Fisher’s presentation was very well received — he did a fabulous job and we received lots of positive feedback — I would definitely bring him back.