The Senate Finance Committee will consider Dartmouth Medical School professor Elliott Fisher's proposal for the creation of "accountable care organizations" in its examination of health care policy reform, which began last week. Fisher, director of The Dartmouth Institute for Health Policy and Clinical Practice's Center for Health Policy Research, is one of several researchers at the institute who has a hand in the current reform effort.
ACOs are networks of health care providers that can provide a full range of medical care for their patients. ACOs would allow the government to measure the performance of providers by making it easier to collect data about health care delivery, Fisher said in an interview with The Dartmouth.
Finance Committee Chairman Sen. Max Baucus, D-Mont., and ranking committee member Sen. Chuck Grassley, R-Iowa, released an "options package" last Tuesday that outlined possible health care reform plans, including Fisher's ACO proposal. The options package, "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs," is similar to a "preliminary health care reform bill," according to Julie Lewis, Fisher's policy assistant.
Almost all physicians and hospitals in the United States can participate in ACOs, Fisher said in the interview. Many health care organizations are already structured like ACOs, including numerous academic medical centers and networks of private practice physicians that include primary care doctors and specialists, Fisher said.
Fisher first proposed the creation of ACOs to Congress when he testified in front of the U.S. House of Representatives Ways and Means Committee in early April.
The research presented to the committee demonstrated that ACOs provide better quality and less expensive health care to patients, Baucus and Grassley wrote in the options package.
Fisher has met with several legislators and their staffs during the past few months to advise Congress about health care reform, Lewis said. The inclusion of the proposal for ACOs in the options package resulted from these meetings, she explained.
"We really try to be a resource for the congressional staff," Lewis said. "They really have a lot of questions about the Dartmouth research. When it comes time to write the legislation, they really focus on the details about how this would work."
Fisher, along with Mark McClellan, the director of the Engelberg Center for Health Care Reform at the Brookings Institution, has implemented ACOs throughout the country in an attempt to evaluate their effectiveness.
ACOs that perform well receive financial support and other incentives through Brookings and The Dartmouth Institute, Fisher said. Fisher said he hopes that the pair's research will definitively show that ACOs can provide less expensive health care with higher quality than traditional health care systems, and persuade Congress to turn their proposal into law.
"It is difficult to predict the future, and we certainly hope many of these ideas will be making it into legislation," he said.
The staff of Sen. Edward Kennedy, D-Mass., the chair of the Senate Committee on Health, Education, Labor and Pensions, has also solicited Fisher's input recently on the committee's un-drafted health care reform proposal, Fisher said. Kennedy's office could not be reached for comment by press time.
Fisher said much of his research grew out of the work of DMS professor John Wennberg, who compared health care quality in different regions of Vermont in 1973 and eventually developed the Dartmouth Atlas of Health Care. The project maps differences in health care provided throughout the United States and has been cited by legislators and advocates for health care reform.
"It really is a testament to the work that he has done," Fisher said. "We feel really lucky to be involved. His work identifying how medical resources are used stimulated all of us to ask these great questions which, to reform the delivery service, all of these ideas are of so much interest to policy makers right now."
Wennberg has advised Sen. Ron Wyden, D-Ore., who serves on the Senate Finance Committee's Subcommittee on Health Care, on his "Healthy Americans Act." The bill, which Wyden introduced for the second time in February 2009, calls for the creation of a universal health care system.
"Senator Wyden considers Dr. Wennberg one of the go-to people in the country for health care and relies on him for advice," Mary Conley, a spokesperson for Wyden, said. "He thinks he's one of the most objective sources of information on underlying health care concerns."
Peter Orszag, the director of the Office of Management and Budget, has used Wennberg's research to call for more efficient health care both in his current position and as director of the Congressional Budget Office from January 2007 to November 2008, according to a profile of Orszag in the May 4 issue of The New Yorker. When Orszag was a fellow at Brookings, Orszag became "obsessed" with the Atlas project, the profile said.
"He has been a real student of Dr. Wennberg and the Atlas, and that became the real basis for his efforts to reform health care," Deborah Kimbell, a spokesperson for The Dartmouth Institute, said.
The White House could not be reached for comment by press time.
