Elliott S. Fisher
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Elliott S. Fisher is a
health policy Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society".World Health Organization''Health Policy'' accessed 22 March 2011(Web archive)/ref> According to the ...
researcher and advocate for improving
health system Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
performance in the United States. He helped develop the concept of
accountable care organization An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitione ...
s and championed their adoption by Medicare. The development of the
Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presid ...
was influenced by his research on disparities in healthcare spending and utilization across the United States. He has strongly supported a rapid transition from
fee-for-service Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality ...
to pay-for-performance models in the U.S. healthcare industry. He is a tenured faculty member at
Dartmouth College Dartmouth College (; ) is a private research university in Hanover, New Hampshire. Established in 1769 by Eleazar Wheelock, it is one of the nine colonial colleges chartered before the American Revolution. Although founded to educate Native A ...
, where he teaches in the
Masters in Public Health The Master of Public Health or Master of Philosophy in Public Health (M.P.H.), Master of Science in Public Health (MSPH), Master of Medical Science in Public Health (MMSPH) and the Doctor of Public Health (Dr.P.H.), International Masters for Healt ...
program.


Personal life and education

Fisher earned a BA from
Harvard College Harvard College is the undergraduate college of Harvard University, an Ivy League research university in Cambridge, Massachusetts. Founded in 1636, Harvard College is the original school of Harvard University, the oldest institution of higher lea ...
in East Asia Studies in 1976; an MD from
Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...
in 1981; and a MPH in health research from the
University of Washington The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington. Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seattle a ...
in 1985. He is the son of late Harvard academic Roger Fisher and brother of Peter R. Fisher.


Career

In 1986, Fisher became a member of the faculty at Dartmouth Medical School (now the
Geisel School of Medicine The Geisel School of Medicine at Dartmouth is the graduate medical school of Dartmouth College in Hanover, New Hampshire. The fourth oldest medical school in the United States, it was founded in 1797 by New England physician Nathan Smith. It is o ...
), where he continues to teach. He also served as a physician at the Veterans Affairs Medical Center in White River Junction, Vermont, from 1986 to 2004. Fisher served as the director of
The Dartmouth Institute for Health Policy and Clinical Practice The Dartmouth Institute for Health Policy and Clinical Practice (TDI) is an organization within Dartmouth College "dedicated to improving healthcare through education, research, policy reform, leadership improvement, and communication with patient ...
from 2013 through 2019 and he served as the institute's Director of the Centers for Population Health and Healthy Policy Research from 2007 through 2009.


Early research on health system performance

A general internist, Fisher's early research focused on the promise and pitfalls of using of large databases, such as vital records, census data, and Medicare claims to study health care. In the last three decades, Fisher led studies that used claims data and other data sources to explore the causes and consequences of the dramatic differences in spending and utilization of health care across the country, research that revealed that the excess spending in high cost regions was largely due to overuse of discretionary—often avoidable—services and that higher utilization was not associated with better quality or health outcomes. He concluded that the United States is wasting a substantial portion of spending on avoidable and potentially harmful care. The landmark research was cited by
Peter R. Orszag Peter Richard Orszag (born December 16, 1968) is the CEO of Financial Advisory at Lazard. Before June 2019, he was the firm's Head of North American M&A and Global Co-Head of Healthcare. Orszag previously served as a Vice Chairman of Corporate ...
as President Barack Obama's administration crafted the
Patient Protection and Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presi ...
.


Accountable care organizations

In the mid-2000s, as consensus emerged that health costs were rising at an unsustainable rate and that fragmented, poorly coordinated care was a major problem, Fisher proposed a new payment and delivery model to encourage groups of physicians, with or without hospitals, to focus on improving quality and avoiding unnecessary expenditures. Fisher and Glen Hackbarth, chair of the Medicare Payment Advisory Commission, came up with the term "
accountable care organization An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitione ...
" (ACO) to describe the model. Fisher then worked with a small group of researchers and policy advocates, including
Mark McClellan Mark Barr McClellan (born June 26, 1963) is the director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy at Duke University. Formerly, he was a senior fellow and director of the ...
, to refine the design of the model and estimate the potential impact on spending. The goal of ACOs is to give systems financial incentives to be efficient and to keep patients out of the hospital. On January 18, 2011, the U.S. Department of Health and Human Services introduced guidelines for the ACO's inclusion in the new health care law.


ReThink Health

In the mid-2000s, the Fannie E. Rippel Foundation convened a small group of thought leaders, including
Donald Berwick Donald M. Berwick (born September 9, 1946) is a former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare I ...
, Elliott Fisher,
Amory Lovins Amory Bloch Lovins (born November 13, 1947) is an American writer, physicist, and former chairman/chief scientist of the Rocky Mountain Institute. He has written on energy policy and related areas for four decades, and served on the US Nationa ...
,
Peter Senge Peter Michael Senge (born 1947) is an American systems scientist who is a senior lecturer at the MIT Sloan School of Management, co-faculty at the New England Complex Systems Institute, and the founder of the Society for Organizational Learning. ...
and
Elinor Ostrom Elinor Claire "Lin" Ostrom (née Awan; August 7, 1933 – June 12, 2012) was an American Political science, political scientist and Political economy, political economist whose work was associated with New institutional economics, New Institutio ...
, to consider the major barriers to reforming health care and improving health in the United States. The group evolved into what is now a national program of the Rippel Foundation that has developed a computer simulation of local health care economies and partnership with the Robert Wood Johnson Foundation to catalyze local health system change.


Research

Fisher's ongoing research is focused on evaluating how current delivery and payment system reforms contribute to improving the quality and cost of health care. He is the principal investigator of the Dartmouth-Berkeley Center of Excellence in Health Systems Performance. He and investigators from the Dartmouth Institute and the
University of California, Berkeley The University of California, Berkeley (UC Berkeley, Berkeley, Cal, or California) is a public land-grant research university in Berkeley, California. Established in 1868 as the University of California, it is the state's first land-grant u ...
, are examining the market and organizational factors that are associated with better health care—and with the successful formation of ACOs and other innovative models of care delivery.


Recognition

In 2009, Fisher appeared on ''
60 Minutes ''60 Minutes'' is an American television news magazine broadcast on the CBS television network. Debuting in 1968, the program was created by Don Hewitt and Bill Leonard, who chose to set it apart from other news programs by using a unique styl ...
'' in a segment titled "The Cost of Dying". He told host Steve Kroft, "I think 30 percent of hospital stays in the United States are probably unnecessary given what our research looks like." He has published over 150 research articles and commentaries and is a member of the
National Academy of Medicine The National Academy of Medicine (NAM), formerly called the Institute of Medicine (IoM) until 2015, is an American nonprofit, non-governmental organization. The National Academy of Medicine is a part of the National Academies of Sciences, En ...
. In 2013 Fisher was named to ''
Modern Healthcare ''Modern Healthcare'' is a twice monthly business publication targeting executives in the healthcare industry. It is an independent American publisher of national and regional healthcare news. The publication is also known for providing statistic ...
''s list of 50 Most Influential Physician Executives in Healthcare.


Misconduct investigation

Fisher was the director of the Dartmouth Institute for Health Policy but was placed on paid administrative leave in August 2018 following a complaint about conduct in the workplace. In April 2019 the investigation concluded; he was demoted from institute director and no longer holds the John E. Wennberg Distinguished Chair in Health Policy. He returned to active faculty status to pursue research, education, and service.


References

{{DEFAULTSORT:Fisher, Elliott Dartmouth College faculty Health policy in the United States Year of birth missing (living people) Living people University of Washington School of Public Health alumni Harvard Medical School alumni Harvard College alumni Members of the National Academy of Medicine