Elliott S. Fisher
Elliott S. Fisher is a researcher and advocate for improving health system performance and the director (now on administrative leave pending completion of investigation of misconduct in the workplace) of The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College. He is the co-founder of ReThink Health and the John E. Wennberg Distinguished Professor of Health Policy, Medicine and Community and Family Medicine at the Geisel School of Medicine at Dartmouth. He is the son of late Harvard academic Roger Fisher and brother of Peter R. Fisher.
In 1986, Fisher became a member of the faculty at Dartmouth Medical School (now the Geisel School of Medicine), 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 assumed the directorship of The Dartmouth Institute for Health Policy and Clinical Practice in 2013, and he served as the institute’s Director of the Centers for Population Health and Healthy Policy Research from 2007 through 2009. In July 2018, Fisher was placed on administrative leave while an investigation proceeds into a complaint about conduct in the workplace. He was also banned from the campus and attending Dartmouth-related events elsewhere.
Early research on health system performance
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 as President Barack Obama’s administration crafted the Patient Protection and Affordable Care Act.
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 (ACO) to describe the model.
Fisher then worked with a small group of researchers and policy advocates, including Mark McClellan, 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 ACOs inclusion in the new health care law.
In the mid-2000s, the Fannie E. Rippel Foundation convened a small group of thought leaders, including Donald Berwick, Elliott Fisher, Amory Lovins, Peter Senge and Elinor Ostrom, 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.
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, 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.
In 2009, Fisher appeared on 60 Minutes in a segment "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. In 2013 Fisher was named to Modern Healthcare's list of 50 Most Influential Physician Executives in Healthcare.
The Dartmouth Institute leave and controversy
Dr. Fisher was the director of the Dartmouth Institute for Health policy but was placed on administrative leave in August of 2018. This was in response to allegations of workplace misconduct. Nothing more is known as of November 2018.
- Practice, Dartmouth Institute of Health Policy & Clinical. "The Dartmouth Institute | Elliott Fisher, MD, MPH". tdi.dartmouth.edu. Retrieved 2017-03-17.
- "Dr. Elliot Fisher named new director of Dartmouth Institute for Health Policy & Clinical Practice". Modern Healthcare. Retrieved 2017-03-17.
- Fisher, E. S.; Whaley, F. S.; Krushat, W. M.; Malenka, D. J.; Fleming, C.; Baron, J. A.; Hsia, D. C. (1992-02-01). "The accuracy of Medicare's hospital claims data: progress has been made, but problems remain". American Journal of Public Health. 82 (2): 243–248. ISSN 0090-0036. PMC 1694279. PMID 1739155.
- Gawande, Atul (2009-06-01). "The Cost Conundrum". The New Yorker. ISSN 0028-792X. Retrieved 2017-03-17.
- "Obamacare's Cost Scalpel". Bloomberg.com. 2010-03-25. Retrieved 2017-03-17.
- Orszag, Peter R. (2014-09-30). "Patient Health Doesn't Explain Cost Differences". Bloomberg View. Retrieved 2017-03-17.
- Sirovich, Brenda; Gallagher, Patricia M.; Wennberg, David E.; Fisher, Elliott S. (2008-05-01). "Discretionary Decision Making By Primary Care Physicians And The Cost Of U.S. Health Care". Health Affairs. 27 (3): 813–823. doi:10.1377/hlthaff.27.3.813. PMC 2438037.
- Barnato, Amber E.; Herndon, M. Brooke; Anthony, Denise L.; Gallagher, Patricia M.; Skinner, Jonathan S.; Bynum, Julie P. W.; Fisher, Elliott S. (2017-03-20). "Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?". Medical Care. 45 (5): 386–393. doi:10.1097/01.mlr.0000255248.79308.41. PMC 2147061.
- Fisher, Elliott S. (2003-02-18). "The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care". Annals of Internal Medicine. 138 (4). doi:10.7326/0003-4819-138-4-200302180-00006.
- "Accountable Care Organization (ACO) | Nalari". www.nalarihealth.com. Retrieved 2017-03-17.
- Fisher, Elliott S.; Staiger, Douglas O.; Bynum, Julie P. W.; Gottlieb, Daniel J. (2007-01-01). "Creating Accountable Care Organizations: The Extended Hospital Medical Staff". Health Affairs. 26 (1): w44–w57. doi:10.1377/hlthaff.26.1.w44. PMC 2131738.
- Fisher, Elliott S.; McClellan, Mark B.; Bertko, John; Lieberman, Steven M.; Lee, Julie J.; Lewis, Julie L.; Skinner, Jonathan S. (2009-03-01). "Fostering accountable health care: moving forward in medicare". Health Affairs (Project Hope). 28 (2): w219–231. doi:10.1377/hlthaff.28.2.w219. PMC 2656392.
- "Accountable Care Organizations, Explained". NPR.org. Retrieved 2017-03-20.
- "The Pioneers | ReThink Health". www.rethinkhealth.org. Retrieved 2017-03-20.
- "Accelerating Health System Transformation By Disrupting The Status Quo". Health Affairs. Retrieved 2017-03-20.
- "Berkeley center part of 5-year $17.5 million collaborative effort to spur innovation in health care". UC Berkeley School of Public Health. 2015-06-17. Retrieved 2017-03-20.
- "The Cost of Dying". Retrieved 2017-03-17.
- "Modern Healthcare | The leader in healthcare business news, research & data". Modern Healthcare. Retrieved 2017-03-17.