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Elliott Fisher: Data-Driven ACO Visionary

 |  By Marianne@example.com  
   December 02, 2010

 "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.

More than 30 years later, Fisher believes the best way to improve healthcare is through accurate information and statistics. Data gathering and analysis is the key to creating successful ACOs, a cornerstone of the new healthcare reform law. Fisher has outlined four goals that need to be met for ACOs to be truly accountable: Clearly defined aims, detailed performance measurement, true integration, and financial incentives aligned with the aims.

A lack in clarity on the aims of healthcare and poor information are major underlying problems in the current delivery system that is contributing to inefficiency and uneven quality of care, Fisher says.

"The notion of accountable care is being accountable in communities," he says. "We have insufficient data on performance that leaves us unsure about how to improve either [efficiency or quality]  because we really have not measured performance adequately. We need meaningful measures of performance that are used to support clinicians in their efforts to improve and reassure the public that they're getting better care."

The current system also has fundamentally uncoordinated care, which leads to a skewed rewards structure. 

"Each physician and hospital performance is measured on individual attributes and there's the payment system rewarding that fragmentation," he says. "There's little integration that helps patients navigate their way through a complex healthcare system. One of the principles of an ACO is creating organizations that support integration for patients. The system we have now simply rewards more care, but we need to align our system so it rewards better care."

The journey to create thriving ACOs will likely take 10 years, Fisher says, as organizations learn what works and what doesn't. He envisions himself working to perfect accountable care for at least the next five years.

"What I'm enjoying doing now is trying to help the major stakeholders in the U.S. healthcare system, from consumer groups to payers to the federal government, figure out how this notion succeeds," he says. "That's collaborative work; it's figuring out how we can get to the measurements that we want. What I hope to create is a learning system that gets us good information about the performance of ACOs and why they succeed and why some were less successful. That allows us to disseminate that knowledge to others so we quickly identify organizational missteps and are able to correct them."

Marianne Aiello is a contributing writer at HealthLeaders Media.

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