"The system we have now simply rewards more care, but we need to align our system so it rewards better care."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Elliott Fisher's story.
When asked where he sees himself in 10 years, Elliott Fisher, MD, MPH, commonly hailed as the father of accountable care organizations, is self effacing. "I might be in hiding because ACOs failed," he jokes.
But when it comes to improving the healthcare system in the United States, Fisher trades facetiousness for data. One of the barriers he has identified that could block the way to creating successful ACOs is insufficient statistics. Fisher, who is also a professor of medicine at Dartmouth Medical School, has been tackling this problem for years, even before 2007 when took over leadership of the Dartmouth Atlas of Health Care, a project dedicated to documenting variations in how medical resources are distributed and used in this country.
"I hope that through the work of the Dartmouth Atlas and our other related work we can help practitioners and the public understand the opportunity we all have to improve health system performance on both cost and quality," Fisher says. "The way we do that is through describing current practice patterns within the U.S. and then research that helps both policy makers and clinicians understand the causes of those variations and what their implications are for healthcare reform and for improving the quality and costs of care for patients."
Fisher first became interested in bettering the healthcare system when he worked as an ambulance driver in the mid-1970s in Somerville, MA, a suburb of Boston.
"I grew up in Cambridge and I'd see kids with asthma or diabetes die in Somerville because the care they were getting wasn't really good," he says. "The differences were stark between Harvard Square and Davis Square," a less affluent neighborhood in Somerville, a few miles from Harvard. "I thought, maybe I could be involved in health policy because healthcare has so much room to improve in many regions," he says.