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Rewarding Provider Performance: Aligning Incentives in Medicare G Biographies AUTHORING COMMITTEE Steven A. Schroeder, M.D., Chair, is distinguished professor of health and health care, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (UCSF), where he also heads the Smoking Cessation Leadership Center. The Center, funded by The Robert Wood Johnson Foundation, works with leaders of American health professional organizations and health care institutions to increase the rate at which patients who smoke are offered help to quit. Between 1990 and 2002 he was president and chief executive officer (CEO) of The Robert Wood Johnson Foundation. During his term of office the foundation made grant expenditures of almost $4 billion in pursuit of its mission of improving the health and health care of the American people. During those 12½ years the foundation developed new programs in substance abuse prevention and treatment, care at the end of life, and health insurance expansion for children, among others. In 1999, it reorganized into health and health care groups, reflecting the twin components of its mission. Dr. Schroeder graduated from Stanford University and Harvard Medical School, and trained in internal medicine at the Harvard Medical Service of Boston City Hospital and in epidemiology as an Epidemic Intelligence Service Officer of the Centers for Disease Control and Prevention. He held faculty appointments at Harvard, George Washington, and UCSF. At both George Washington and UCSF he was founding medical director of a university- sponsored health maintenance organization (HMO), and at UCSF he founded the
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Rewarding Provider Performance: Aligning Incentives in Medicare company’s division of general internal medicine. Dr. Schroeder has produced more than 260 publications in the fields of clinical medicine, health care financing and organization, prevention, public health, and the workforce. He recently completed his term as chair of the American Legacy Foundation and chair of the International Review Committee of the Ben Gurion School of Medicine. He is a member of the editorial board of the New England Journal of Medicine and the Harvard Overseers, and a director of the James Irvine Foundation, the Save Ellis Island Foundation, and the Charles R. Drew University of Medicine and Science. He holds six honorary doctoral degrees and has received numerous awards. Robert D. Reischauer, Ph.D., Co-Chair, Pay for Performance Subcommittee,* is president of the Urban Institute, a nonprofit, nonpartisan policy research and education organization that examines the social, economic, and governance problems facing the nation. He served as director of the Congressional Budget Office (CBO) between 1989 and 1995 and was CBO’s assistant director for human resources and deputy director during 1977 to 1981. Dr. Reischauer has been a senior fellow in the Economic Studies Program of the Brookings Institution (1986–1989 and 1995–2000) and senior vice president of the Urban Institute (1981–1986). He is an economist with an undergraduate degree from Harvard and a Ph.D. in economics and masters in international affairs from Columbia University. Dr. Reischauer is a member of the Harvard Corporation and serves on the boards of several educational and nonprofit organizations. He is vice-chair of the Medicare Payment Advisory Commission (MedPAC) and served as chair of the National Academy of Social Insurance’s project “Restructuring Medicare for the Long Term” from 1995 through 2004. Gail R. Wilensky, Ph.D., Co-Chair, Pay for Performance Subcommittee,* is a senior fellow at Project HOPE, an international health education foundation, where she analyzes and develops policies relating to health reform and to ongoing changes in the medical marketplace. Dr. Wilensky testifies frequently before congressional committees; acts as an advisor to members of Congress and other elected officials; and speaks nationally and internationally before professional, business, and consumer groups. From 2001 to 2003, she cochaired the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans, which addressed health care for both veterans and military retirees. From 1997 to 2001 she chaired the Medicare Payment Advisory Commission, which advises Congress on payment and other issues relating to Medicare, and from 1995 to 1997 she chaired the * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare Physician Payment Review Commission. Previously, she served as deputy assistant to President G.H.W. Bush for policy development, advising him on health and welfare issues. Prior to that, she was administrator of the Healthcare Financing Administration (HCFA), overseeing the Medicare and Medicaid programs. Dr. Wilensky is an elected member of the Institute of Medicine (IOM) and its Governing Council, serves as a trustee of the Combined Benefits Fund of the United Mineworkers of America and the American Heart Association, and is on the Advisory Board of the National Institute of Health Care Management. She is an advisor to The Robert Wood Johnson Foundation and The Commonwealth Fund, immediate past chair of the Board of Directors of AcademyHealth, and a director on several corporate boards. Dr. Wilensky received a bachelor’s degree in psychology and a Ph.D. in economics at the University of Michigan. Bobbie Berkowitz, Ph.D., R.N., F.A.A.N., is alumni endowed professor of nursing at the University of Washington (UW) School of Nursing and adjunct professor in the School of Public Health and Community Medicine. She directs the “Turning Point” initiative funded by The Robert Wood Johnson Foundation and the Center for the Advancement of Health Disparities Research funded by the National Institute of Nursing Research. She serves on the board of directors as vice-chair of Qualis Health, the Quality Improvement Organization of Washington State. Before joining UW, Dr. Berkowitz was deputy secretary of health for the Washington State Department of Health. She is a member of the board of trustees for Group Health Cooperative, a fellow in the American Academy of Nursing, and a member of the IOM. She served as co-chair of the IOM Committee on Using Performance Monitoring to Improve Community Health and as vice-chair of the IOM/Transportation Research Board Committee on Physical Activity, Health, Transportation, and Land Use. She holds a Ph.D. in nursing science from Case Western Reserve University. Donald M. Berwick, M.D., M.P.P., is president and CEO of the Institute for Healthcare Improvement (IHI), a not-for-profit organization helping to accelerate the improvement of health care throughout the world. He is clinical professor of pediatrics and health care policy at Harvard Medical School and professor of health policy and management at Harvard School of Public Health. He is also a pediatrician, an associate in pediatrics at Boston’s Children’s Hospital, and a consultant in pediatrics at Massachusetts General Hospital. Dr. Berwick has published over 110 scientific articles in numerous professional journals on subjects relating to health care policy, decision analysis, technology assessment, and health care quality management. He serves on the IOM’s Governing Council and the IOM’s Board on Global Health. He is also a member of several editorial boards, including that of
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Rewarding Provider Performance: Aligning Incentives in Medicare the Journal of the American Medical Association. A summa cum laude graduate of Harvard College, Dr. Berwick holds a master of public policy degree from the John F. Kennedy School of Government and an M.D. cum laude from Harvard Medical School. Bruce E. Bradley, M.B.A., is director of Health Care Plan Strategy and Public Policy, Health Care Initiatives, for General Motors Corporation in Pontiac, Michigan. He is responsible for health care–related strategy and public policy, with a focus on quality measurement and improvement, consumer engagement, and cost-effectiveness. General Motors provides health care coverage for over 1.1 million employees, retirees, and their dependents, with an annual expense of $5.2 billion. Mr. Bradley joined General Motors in June 1996 after 5 years as corporate manager of Managed Care for GTE Corporation. In addition to his health care management experience at GTE, he spent nearly 20 years in health plan and HMO management. From 1972 to 1980 he was executive director of the Matthew Thornton Health Plan, Nashua, New Hampshire. From 1980 to 1990 he was president and CEO of the Rhode Island Group Health Association in Providence, a staff model HMO. He was cofounder of the HMO Group (now the Alliance of Community Health Plans), a national corporation of 15 nonprofit, independent group practice HMOs, and the HMO Group Insurance Co., Ltd. Mr. Bradley has gained recognition for his work in achieving health plan quality improvement and for his efforts in developing the Health Plan Employer Data and Information Set measures and processes. He is a board member of the National Quality Forum (NQF), past member of the board of the Foundation for Accountability, board member of the American Board of Internal Medicine Foundation, past board member of the Academy for Health Services Research and Policy, and founding member and past chair of the Leapfrog Group board. A native of Pelham, New York, Mr. Bradley holds a bachelor’s degree in psychology from Yale University (1967) and a master’s degree in business and health care administration from the Wharton School at the University of Pennsylvania (1972). Janet M. Corrigan, Ph.D.,* is president and CEO of the NQF, a private, not-for-profit membership organization established in 1999 to develop and implement a national strategy for health care quality measurement and reporting. The NQF portfolio includes the endorsement of performance measurement consensus standards, educational programs for health care leaders on key environmental trends, and award recognition programs. Dr. Corrigan was instrumental in organizing the merger between NQF and the * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare National Committee for Quality Health Care (NCQHC), where she served as president and CEO from June 2005 to March 2006. Prior to joining NCQHC in June 2005, she was senior board director at the IOM, where she was responsible for the Board on Health Care Services’ portfolio of initiatives on quality and safety, health services organization and financing, and health insurance issues. She provided leadership for the IOM’s Quality Chasm series, which includes 10 reports produced during her tenure, among them To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. She serves on the boards of the Baldrige Board of Overseers and the National Center for Healthcare Leadership. She received her doctorate in health services research, a master of industrial engineering degree from the University of Michigan, and master’s degrees in business administration and community health from the University of Rochester. Karen Davis, Ph.D.,* is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social issues. A nationally recognized economist, she has had a distinguished career in public policy and research. She served as deputy assistant secretary for health policy in the U.S. Department of Health and Human Services from 1977 to 1980 and holds the distinction of being the first woman to head a U.S. Public Health Service agency. Prior to her government career, Dr. Davis was a senior fellow at the Brookings Institution in Washington, D.C., a visiting scholar at Harvard University, and an assistant professor of economics at Rice University. She was chair of health policy and management at the Johns Hopkins Bloomberg School of Public Health from 1981 to 1992. She also serves on the board of Geisinger Health System. She is the recipient of the 2000 Baxter-Allegiance Foundation Prize for Health Services Research and the 2006 AcademyHealth Distinguished Investigator Award. She is a former president of AcademyHealth. Dr. Davis received her doctorate in economics from Rice University and was awarded an honorary doctorate in humane letters from The Johns Hopkins University in 2001. Nancy-Ann Min DeParle, J.D., is a senior advisor to JPMorgan Partners, LLC, and adjunct professor of health care systems at the Wharton School of the University of Pennsylvania. From 1997 to 2000, she served as administrator of HCFA, now the Centers for Medicare and Medicaid Services. Before joining HCFA, Ms. DeParle was associate director for health and personnel at the White House Office of Management and Budget. From 1987 to 1989 she served as the Tennessee commissioner of human services. She is * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare a member of MedPAC; a trustee of The Robert Wood Johnson Foundation; and a board member of Cerner Corporation, DaVita, Boston Scientific, Triad Hospitals, and the NQF. Ms. DeParle received a bachelor’s degree from the University of Tennessee; bachelor’s and master’s degrees from Oxford University, where she was a Rhodes Scholar; and a J.D. degree from Harvard Law School. Elliott S. Fisher, M.D., M.P.H.,* is professor of medicine and community and family medicine and director of the Institute for the Evaluation of Medical Practice at the Center for the Evaluative Clinical Sciences, Hanover, New Hampshire, and senior associate of the VA Outcomes Group, Veterans Administration Medical Center, White River Junction, Vermont. He is a general internist and former Robert Wood Johnson clinical scholar with broad expertise in the use of administrative databases and survey research methods in health systems evaluation. His research has focused on exploring the causes and consequences of variations in clinical practice and health care spending across U.S. regions and among health care providers. Richard G. Frank, Ph.D., is Margaret T. Morris professor of health economics in the Department of Health Care Policy at Harvard Medical School. He is also a research associate with the National Bureau of Economic Research. Dr. Frank is a member of the IOM. He advises several state mental health and substance abuse agencies on issues related to managed care and financing of care. He also serves as coeditor for the Journal of Health Economics. Dr. Frank was awarded the Georgescu-Roegen prize from the Southern Economic Association for his collaborative work on drug pricing, the Carl A. Taube Award from the American Public Health Association for outstanding contributions to mental health services and economics research, and the Emily Mumford Medal from Columbia University’s Department of Psychiatry. In 2002 Dr. Frank received the John Eisenberg Mentorship Award from National Research Service Awards. Robert S. Galvin, M.D.,* is director of Global Health Care for General Electric (GE). He is in charge of the design and performance of GE’s health programs, totaling over $3 billion annually, and oversees the 1 million patient encounters that take place in GE’s 220 medical clinics in more than 25 countries. Drawing on his clinical expertise and training in Six Sigma, Dr. Galvin has been an advocate and leader in extending the benefits of this methodology to health care. He has focused on issues of market-based health policy and financing, with special interests in measurement transpar- * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare ency, payment system reform, and the assessment and coverage of new technologies. He is a past member of the Strategic Framework Board of the NQF and is currently on the board of the National Committee for Quality Assurance. He is a cofounder of the Leapfrog Group, the founder of Bridges to Excellence, and a member of the Advisory Group of the Council on Health Care Economics and Policy. Dr. Galvin is widely published on issues affecting the purchaser side of health care. He is professor adjunct of medicine at Yale, where he directs the seminar series on the private sector for the Robert Wood Johnson Clinical Scholars fellowship. He is a fellow of the American College of Physicians. David H. Gustafson, Ph.D., is a research professor at the University of Wisconsin, Madison, where he directs the Center of Excellence in Cancer Communications (designated by the National Cancer Institute) and the Network for the Improvement of Addiction Treatment (supported by The Robert Wood Johnson Foundation and the federal government’s Center for Substance Abuse Treatment). His research focuses on the use of systems engineering methods and models in individual and organizational change. Much of his research centers on the development and evaluation of health systems to support people facing serious health problems such as cancer. His randomized controlled trials and field tests have helped in understanding the acceptance, use, and impact of e-health on quality of life, behavior change, and health service utilization. His research has also contributed to organizational improvement, with particular attention to models that predict and explain organizational change. Dr. Gustafson is a fellow of the Association for Health Services Research and of the American Medical Informatics Association and a fellow and past vice-chair of the board of IHI. He also chaired the recent Federal Science Panel on Interactive Communications in Health and is chair of the Health Institute. He is a former member of the University of Wisconsin Athletic Board. Mary Anne Koda-Kimble, Pharm.D., is dean of the School of Pharmacy at UCSF, where she teaches and has cared for patients at the UCSF Diabetes Center. She holds the Thomas J. Long Endowed Professorship and previously served as chair of the Department of Clinical Pharmacy. Dr. Koda-Kimble received her Pharm.D. from UCSF and joined its faculty in 1970, where she was involved in developing an innovative clinical pharmacy curriculum. She is a member of the United States Pharmacopoeia board of trustees and was vice-chair of the Accreditation Council of Pharmaceutical Education board of Directors. She is past president of the American Association of Colleges of Pharmacy and has served on the California State Board of Pharmacy, the Food and Drug Administration’s Nonprescription
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Rewarding Provider Performance: Aligning Incentives in Medicare Drugs Advisory Committee, and many other boards and task forces of national professional associations. Dr. Koda-Kimble is frequently invited to address national and international groups and has produced many publications, the best known of which is Applied Therapeutics, a text widely used by health professional students and practitioners throughout the world. Alan R. Nelson, M.D., is an internist–endocrinologist who was in private practice in Salt Lake City, Utah, until becoming CEO of the American Society of Internal Medicine (ASIM) in 1992. Following the merger of ASIM with the American College of Physicians (ACP) in 1998, Dr. Nelson headed the Washington Office of ACP–ASIM until his semiretirement in January 2000; he currently serves as special advisor to the executive vice president/ CEO of the college. He was president of the American Medical Association and from 2000 to 2006 served as a member of MedPAC, which advises Congress on Medicare issues. A member of the IOM, he was chair of the IOM Committee on Ethnic and Racial Disparities in Health Care and is a coeditor of the study report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Dr. Nelson attended Utah State University and received his M.D. from Northwestern University in 1958. Norman C. Payson, M.D., was selected to be chairman of the board of Concentra, Inc. As chairman, he oversees its strategic direction, management development and guidance, and governance. Dr. Payson was previously CEO of two publicly traded health plans—Oxford Health Plans as the “turnaround CEO” (1998–2002) and Healthsource, Inc. as cofounder and CEO (1985– 1997). Prior to joining Healthsource, Dr. Payson was CEO and Medical Director of a 120-doctor physician group practice. Dr. Payson is a board member of the Mailman School of Public Health at Columbia University; Medicine in Need Corporation, a charitable biotechnology company; and the City of Hope in Los Angeles. He serves on the advisory board of the Health Sciences Technology Division at MIT–Harvard Medical School and the board of overseers at Dartmouth Medical School. Dr. Payson is a graduate of the Massachusetts Institute of Technology and Dartmouth Medical School. He lives in Hopkinton, New Hampshire, with his wife, Melinda. William A. Peck, M.D., became Alan A. and Edith L. Wolff Distinguished Professor of Medicine and director of the Washington University Center for Health Policy in 2003. From 1989 to 2003 he served as dean of Washington University School of Medicine and vice chancellor for medical affairs (executive vice chancellor from 1993 to 2003), and president of the Washington University Medical Center. Dr. Peck was awarded an honorary doctor of science degree from the University of Rochester in 2000. His academic
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Rewarding Provider Performance: Aligning Incentives in Medicare activities include original investigations in bone and mineral metabolism, extensive clinical teaching, as well as patient care experience. He was founding president of the National Osteoporosis Foundation and has served on the editorial boards of multiple journals, on numerous national and international medical and scientific panels, and on advisory boards of major pharmaceutical companies. He has held numerous lectureships and society memberships, including the American Society for Clinical Investigation, the Association of American Physicians, and the Institute of Medicine (NAS). Dr. Peck is the recipient of many international, national, and regional awards. He serves on the boards of Allied Health Care Products, Angelica Corporation, TIAA-CREF Trust Company, and Research!America (vice-chair), and is a trustee of the University of Rochester. Dr. Peck is past chairman of the American Association of Medical Colleges. He has been a consultant for many major pharmaceutical companies. Neil R. Powe, M.D., M.P.H., M.B.A.,* is professor of medicine, professor of health policy and management, and professor of epidemiology at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. He also is director of the Welch Center for Prevention, Epidemiology and Clinical Research, an interdisciplinary research and training center at the Johns Hopkins Medical Institutions focused on population-based and health services research. Dr. Powe’s research has involved clinical epidemiology, technology assessment, patient outcomes research, and health services research in many areas of medicine. He has also studied physician decision making and other determinants of the use of medical practices, including payers’ decisions about insurance coverage for new medical technologies; the effect of financial incentives on the use of technology; efficiency and outcomes in for-profit versus nonprofit health care institutions; and the relationships among hospital volume, technology, and outcomes. He has extensive experience in developing and measuring outcomes and quality of care for chronic kidney disease and is author of more than 250 articles. Dr. Powe received his M.D. from Harvard Medical School, M.P.H. from Harvard School of Public Health, and M.B.A. from the University of Pennsylvania. He completed his residency at the Hospital of the University of Pennsylvania, where he was also a Robert Wood Johnson Clinical Scholar and fellow in the Division of General Internal Medicine. Dr. Powe is a member of the American Society of Clinical Investigation, the Association of American Physicians, and the American Society of Epidemiology. * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare Christopher Queram, M.A.,* has been president/CEO of the Wisconsin Collaborative for Healthcare Quality (WCHQ) since November 2005. The collaborative is a nonprofit, 501c3 voluntary consortium of organizations leading and working together to improve the quality and cost-effectiveness of health care for the people of Wisconsin. The collaborative develops and reports comparative measures of health care performance; designs and promotes quality improvement initiatives; and advocates for enlightened policy to support its work. Prior to joining WCHQ, Mr. Queram served as CEO of the Employer Health Care Alliance Cooperative (the Alliance) of Madison, Wisconsin, a health care purchasing cooperative owned by more than 160 member companies. In addition to his responsibilities at WCHQ, Mr. Queram is a board member of the Joint Commission on Accreditation of Health Care Organizations and Delta Dental of Wisconsin, a member of the “Principals” for the Hospital Quality Alliance (HQA), and a member of the steering committee for the Wisconsin Hospital Association’s CheckPoint quality reporting initiative. Previously, he served as board member of the Leapfrog Group and the NQF, as well as a member of the IOM’s Committee on the Consequences of Uninsurance and President Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Mr. Queram holds a master of arts degree in health services administration from the University of Wisconsin, Madison, and is a fellow in the American College of Healthcare Executives. William C. Richardson, Ph.D., is past president and CEO emeritus of the W. K. Kellogg Foundation and president emeritus of The Johns Hopkins University. Before joining the foundation in August 1995, Dr. Richardson was president of Johns Hopkins, a position he had held since 1990, and professor of health policy and management at the university. Dr. Richardson has been a member of the IOM since 1981, a fellow of the American Academy of Arts and Sciences, and a member of the American Public Health Association. He has chaired several IOM committees. He has also served on the boards of the Council of Michigan Foundations and the Council on Foundations (trustee and chair). He serves as well on the board of directors of the Kellogg Company, CSX Corporation, the Bank of New York, and Exelon Corporation. Dr. Richardson is a graduate of Trinity College and the University of Chicago. Cheryl M. Scott, M.H.A.,* is currently president emerita for Group Health Cooperative (GHC), one of the the nation’s largest consumer-governed, nonprofit health care systems. From 1997 to 2004, she was GHC’s president and * Member of the Subcommittee on Pay for Performance.
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Rewarding Provider Performance: Aligning Incentives in Medicare CEO. Prior to assuming her position in 1997, she served as GHC’s executive vice president/chief operating officer. Ms. Scott is a clinical professor in the Department of Health Services at the University of Washington. At the national level, she served on the board of the Alliance of Community Plans (trustee and chair) and the board of America’s Health Insurance Plans. She currently serves as board chair for the Health Technology Center and is a trustee for the Washington State Life Sciences Discovery Fund. Ms. Scott received a bachelor’s degree in communications and a master’s degree in health administration from the University of Washington. Stephen M. Shortell, Ph.D., M.P.H., is a prominent researcher in health policy and organization behavior at the University of California, Berkeley, and is dean of the School of Public Health. Dr. Shortell is known as a leading academic voice advocating reform of the nation’s health system. His research has helped establish determinants of health outcomes and quality of care for health care organizations. As Blue Cross of California distinguished professor of health policy and management, Dr. Shortell holds a joint appointment at UC Berkeley’s School of Public Health and the Haas School of Business. He also is affiliated with UC Berkeley’s Department of Sociology and UC San Francisco’s Institute for Health Policy Studies. Dr. Shortell is an elected member of the IOM. He has received the Baxter-Allegiance Prize, considered the highest honor worldwide in the field of health services research. He also has received the Distinguished Investigator Award from the Association for Health Services Research and the Gold Medal award from the American College of Healthcare Executives for his contributions to the field. He serves on the boards of the Health Research and Educational Trust and the National Center for Healthcare Leadership. Dr. Shortell received his bachelor’s degree from the University of Notre Dame; his master’s degree in public health from the University of California, Los Angeles; and his Ph.D. in behavioral science from the University of Chicago. Before coming to UC Berkeley in 1998, he held teaching and research positions at Northwestern University, the University of Washington, and the University of Chicago. Samuel O. Thier, M.D., is professor of medicine and professor of health care policy at Harvard Medical School. He was president and CEO of Partners HealthCare System from 1996 to 2002. From 1994 to 1997 he was president of the Massachusetts General Hospital; he was Brandeis University’s president during the previous 3 years. He served 6 years as president of the IOM and 11 years as chair of the Department of Internal Medicine at Yale University School of Medicine, where he was Sterling professor. Dr. Thier is an authority on internal medicine and kidney disease and is also known for his expertise in national health policy, medical education, and
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Rewarding Provider Performance: Aligning Incentives in Medicare biomedical research. Born in New York, he attended Cornell University and received his medical degree from the State University of New York at Syracuse in 1960. He served on the medical staff of Massachusetts General Hospital as an intern, resident, chief resident in medicine, and chief of the renal unit, and held a faculty appointment at Harvard. Prior to joining the faculty of Yale in 1975, he was professor and vice-chair of the Department of Medicine at the University of Pennsylvania. He has received several honorary degrees and the UC Medal of the University of California, San Francisco. He has served as president of the American Federation of Clinical Research and chair of the American Board of Internal Medicine and is a master of the American College of Physicians, a fellow of the American Academy of Arts and Sciences, and a member of the American Philosophical Society. Dr. Thier is a director of Charles River Laboratories, Inc., The Commonwealth Fund (chair), the Federal Reserve Bank of Boston, and Merck & Co., Inc., and a member of the Board of Overseers of TIAA-CREF and the Board of Overseers of Cornell University Medical College. ADVISORY SUBCOMMITTEE ON PAY FOR PERFORMANCE The members of the advisory subcommittee listed below supported, but were not part of, the main authoring committee. Stephanie Alexander, M.B.A., is senior vice president for Premier Healthcare Informatics. She has been active in the health care decision-support business for 20 years and speaks regularly on the importance of measurement to realize consistent health care improvement. Earlier in her career, she served as project manager for operational improvement consulting engagements, resulting in multimillion dollar savings for health systems. She also served as director of process improvement for a 450-bed hospital and managed process improvement programs in several hospitals. She was deeply involved in the development of Premier’s Perspective™ system, which hospitals use for measurement, benchmarking, and reporting of clinical performance. She is an engineering graduate of North Carolina State University and holds an MBA from the University of North Carolina at Chapel Hill. Charles D. Baker is president and CEO of Harvard Pilgrim Health Care, Inc. (HPHC), one of New England’s leading nonprofit health plans. Harvard Pilgrim and its affiliates are licensed to provide comprehensive health insurance solutions in Massachusetts, Maine, and New Hampshire. Its provider network has more than 22,000 physicians and 135 hospitals in Massachusetts, Maine, New Hampshire, and Rhode Island. HPHC offers health and benefit plan solutions to over 970,000 members in New England. He was brought in as CEO in mid-1999 to turn around the organization’s financial
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Rewarding Provider Performance: Aligning Incentives in Medicare performance. HPHC has posted positive gains for 24 consecutive quarters, is rated Ba1 with a “stable” outlook by Moody’s Investors Services, and has over $325 million in net worth. In addition, HPHC finished first in the country for two years in a row on the National Committee for Quality Assurance’s (NCQA’s) annual ranking of health plan performance. HPHC was also featured this year as the #1 health plan in the country in a special issue of U.S. News & World Report, and has won several JD Power “Plan of Distinction” awards. HPHC is a market leader in the development and use of secure, online tools to reduce administrative costs and improve the accuracy and speed of health care transactions. Its chief tool, HPHConnect, is serving thousands of employers, providers and members, offering 24/7 administrative support for a wide variety of transactions. HPHConnect currently supports over 1 million transactions a month for HPHC providers, employers and members. Arnold M. Epstein, M.D., M.A., is chairman of the Department of Health Policy and Management at the Harvard University School of Public Health where he is the John H. Foster Professor, and chief of the Section on Health Services and Policy Research in the Department of Medicine at the Brigham and Women’s Hospital. Dr. Epstein’s research interests focus on quality of care and access to care for disadvantaged populations. Recently his efforts have focused on racial and ethnic disparities in care, public reporting of quality performance data and incentives for quality improvement. He has published 175 articles on these and other topics. His book, Falling Through the Safety Net, Insurance Status and Access to Health Care, won the Kulp Wright Award by the American Risk and Insurance Association in 1994 for the best new book on life and health insurance. During 1993–1994, he worked for the White House where he had staff responsibility for policy issues related to the health care delivery system, especially quality management. He was Vice Chair of the IOM Committee on Developing a National Report on Health Care Quality, and Co-Chair of the Performance Measurement Coordinating Committee of the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), the NCQA, and the American Medical Association. He has served as Chairman of the Board of AcademyHealth and remains on its Board now. He serves on JCAHO’s Advisory Council on Performance Measurement. He has served on several editorial boards including Health Services Research and the Annals of Internal Medicine. He has been elected to the American Society for Clinical Investigation and the American Association of Professors. He is currently Associate Editor for Health Policy at the New England Journal of Medicine and a member of the IOM.
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Rewarding Provider Performance: Aligning Incentives in Medicare Sam Ho, M.D., is currently chief medical officer for UnitedHealthcare’s Pacific and Southwest regions, and is responsible for the clinical advancement of members in the western United States. Previously, he was the executive vice president and chief medical officer for PacifiCare Health Systems, and was responsible for improving the quality, costs, and access for both commercial and Medicare beneficiaries. He led all quality improvement and clinical management programs, medical informatics, and established innovative programs and results in such areas as provider profiling; consumer transparency; value-based networks and product design; pay for performance; consumer incentives for healthier behavior; disease management; and health IT. Such efforts helped distinguish PacifiCare as a pioneer in the managed care industry, earning awards from the National Business Group on Health, the NCQA, the Foundation for Accountability, and the Disease Management Association of America. In 2003 he received the Health Insurance Association of America’s 2003 Innovator Award for innovative leadership in health insurance, and he is nationally recognized in the areas of health policy, program innovation, and operational execution with continuously improved results. Barbara Manard, Ph.D., a health policy researcher and consultant with over 20 years of experience, joined the American Association of Homes and Services for the Aging (AAHSA) in 2003 as vice president of long-term care/ health strategies. Prior to joining AAHSA, she served as vice president of The Lewin Group (1981–1987) and subsequently as president of a Maryland-based research and consulting firm, the Manard Company (1998–2002). In 1998, she served as a Special Expert Consultant to the Office of the Secretary (ASPE), United States Department of Health and Human Services, to assist with technical and policy issues related to implementing post–acute care Medicare payment system changes mandated by Congress. In 2001, she assisted ASPE with a project regarding post–acute care assessment instruments, reference vocabularies, and electronic medical records. Prior to joining the Lewin Group, Dr. Manard served as a policy analyst at ASPE and as an assistant professor of sociology at the University of California (Riverside). She received her doctorate in sociology from the University of Virginia, a certificate in health planning from the University of Virginia School of Medicine, and an AB from Vassar College. L. Gordon Moore, M.D., a faculty member of the IHI, he works with office practice teams from across the United States, helping them pilot and implement open/advanced access scheduling, office efficiency, and the improvement of chronic illness and preventive care with the McColl Institute’s Care Model. He is coleading a clinical transformation project as part of a ground-breaking initiative to re-weave the safety net in Rochester, New York
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Rewarding Provider Performance: Aligning Incentives in Medicare (www.rsafetynetproject.com), creating the platform for transformative change through innovations in health care financing. Dr. Moore maintains a private solo practice in family medicine in Rochester, New York, and is a clinical assistant professor with the University of Rochester Departments of Family Medicine and Community and Preventive Medicine. Debra L. Ness, M.S., is president of the National Partnership for Women & Families. Drawing on an extensive background in health and public policy, she possesses a unique understanding of the issues that face women and families at home, in the workplace, and in the health care arena. Before assuming her current role, she served as the National Partnership’s Executive Vice President for 13 years. She graduated summa cum laude from Drew University with a bachelor’s degree in psychology and sociology and has a Masters of Science degree from the Columbia University School of Social Work. She is a member of the Board of Directors and chairs the Consumer Advisory Council of the NCQA, the nation’s leader in accrediting and developing quality measures for managed care organizations. She is on the Board and is Vice Chair of the Consumer Council of the NQF, established by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry to implement a national strategy on quality protections. She sits on the Board of the Leapfrog Group, which identifies problems and proposes solutions to improve hospital systems. She serves on the Public Advisory Group on Health Care Quality of JCAHO. She is on the Steering Committee of the Ambulatory care Quality Alliance (AQA) and was recently appointed to the HQA/AQA Quality Alliance Steering Committee formed in August 2006 by HHS Secretary Leavitt, and she serves as the co-chair of the Cost/Price Transparency Working Group. Additionally, she serves on the Executive Committee of the Leadership Conference on Civil Rights (LCCR) and co-chairs the LCCR’s Health Care Task Force. W. Allen Schaffer, M.D., F.A.C.P., was former chief clinical officer for CIGNA and senior vice president of clinical strategy and health policy. He led a team that helped develop CIGNA’s clinical public policy and was responsible for articulating the company’s initiatives to improve health outcomes, ensure patient safety, and provide integrated patient-centered health benefits. He also served as privacy officer for CIGNA HealthCare and was responsible for advocacy outreach and external clinical relationships. Dr. Schaffer received his medical degree in 1975 from the University of Washington in Seattle, where he was granted early admission and received both medical thesis honors and the Robert H. Williams Medical Research Award.
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Rewarding Provider Performance: Aligning Incentives in Medicare He served his residency training at the Tulane Service of Charity Hospital in New Orleans and at Baptist Memorial Hospital in Memphis. He has held clinical faculty appointments in the Departments of Medicine at the University of Connecticut School of Medicine and at the University of Louisville School of Medicine. A fellow of the American College of Physicians, Dr. Schaffer has been published in a number of medical and professional journals, including the New England Journal of Medicine and the Annals of Internal Medicine. He currently serves on the board of the Jacobs Institute of Women’s Health and the Bazelon Center for Mental Health Law. He has previously served on the boards of NCQA, the American Association of Health Plans, and the National Advisory Board for the Agency for Heathcare Research and Quality (AHRQ). John Toussaint, M.D., is the CEO of ThedaCare Inc. ThedaCare is comprised of 4 hospitals and 21 clinics as well as other components of care including home care, hospice, seniors, and behavioral health. ThedaCare partners with local employers to decrease their targeted healthcare spend, bringing on-site innovative solutions to directly manage their costs. ThedaCare serves a seven-county region. Dr. Toussaint is an internist who has served multiple roles at ThedaCare including chief of the medicine department to chief medical officer. He has been president and CEO of ThedaCare, since March of 2000. He has been responsible for introducing the ThedaCare Improvement System which is derived from the Toyota Production system. This model of continuous improvement is transforming ThedaCare to the same level of quality performance only achieved by manufacturing companies. He is past chairman of the Wisconsin Collaborative for Healthcare Quality, which has been responsible for publicly reporting and improving performance in healthcare organizations in Wisconsin since 2003. Presently, he is the chairman of the Wisconsin Health Information Organization, a public private partnership centered on reporting provider efficiency using a centralized claims database derived from the major payers in the state. He has recently been appointed to Governor Doyle’s e-Health and Patient Safety Board. ThedaCare’s work has been featured in many publications some of which include The Wall Street Journal, Modern Healthcare, and Health Management Technology. He received his B.S. in chemistry from Cornell College in 1978, M.D. from the University of Iowa in 1982, and Internal Medicine residency from the University of Iowa, Iowa Methodist program in 1985. He has served as a adjunct professor at UW Medical School and resides in Appleton, Wisconsin.
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Rewarding Provider Performance: Aligning Incentives in Medicare INSTITUTE OF MEDICINE STAFF Rosemary A. Chalk† is director of the Board on Children, Youth and Families (BCYF) and also serves as director of the Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement (PPPI) Programs at the IOM. She has been a senior staff member of the IOM and the Division on Behavioral and Social Sciences and Education of the National Academies for almost 19 years, directing studies on vaccines and immunization finance, educational finance, family violence, child abuse and neglect, and research ethics. She took on the role of BCYF director in September 2003 and began directing the PPPI project in April 2005. For 3 years (2000 to 2003), Ms. Chalk was a half-time study director at the IOM and also directed the child abuse/family violence research area at Child Trends, a nonprofit research center in Washington, D.C., where she conducted studies on the development of child well-being indicators for the child welfare system. Over the past decade, Ms. Chalk has directed a range of projects sponsored by the William T. Grant Foundation, the Doris Duke Charitable Foundation, the Carnegie Corporation of New York, The David and Lucile Packard Foundation, and various agencies within the U.S. Department of Health and Human Services. Earlier in her career, Ms. Chalk was a consultant and writer for a broad array of science and society research projects. She has authored publications on issues related to child and family policy, science and social responsibility, research ethics, and child abuse and neglect. She was the first program head of the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science from 1976 to 1986 and is a former section officer for that organization. She served as a science policy analyst for the Congressional Research Service at the Library of Congress from 1972 to 1975. She holds a bachelor’s degree in foreign affairs from the University of Cincinnati. Karen Adams, Ph.D., M.T. (A.S.C.P.),‡ was a senior program officer at the IOM. She was lead staff member on the Performance Measurement and Pay for Performance Subcommittees of the IOM’s congressionally mandated study Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. Her prior work at the IOM includes serving as study director of the Committee on Priority Areas for National Action: Transforming Health Care Quality and co–study director of the 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. Before joining the IOM, she held the rank of assistant professor in the De- † Served through July 2006. ‡ Served through February 2006.
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Rewarding Provider Performance: Aligning Incentives in Medicare partment of Medical and Research Technology, University of Maryland School of Medicine, and was also academic coordinator of the undergraduate medical technology program. She received an undergraduate degree in medical technology from Loyola College, a master’s degree in management from the College of Notre Dame, and a doctorate in health policy from the University of Maryland. During her doctoral studies she was awarded an internship at AHRQ, during which she researched more than 30 years of innovations in medical informatics. She is also certified as a medical technologist by the American Society of Clinical Pathologists. Samantha M. Chao, M.P.H., is senior health policy associate for the IOM’s Board on Health Care Services. She completed a master’s degree in health policy with a concentration in management at the University of Michigan School of Public Health. As part of her studies, she interned with the American Heart Association, where she helped develop the association’s position on pay for performance. She also worked with the Michigan Department of Community Health to promote the study of chronic disease and disease prevention. Ms. Chao is currently developing a Forum on the Science of Health Care Quality Improvement and Implementation at the IOM to better understand and enhance recognition of the need for such research. Tracy A. Harris, D.P.M., M.P.H., joined the IOM’s Board on Health Care Services in 2004 as a program officer. Her work background includes clinical experience and health policy work. Previously, she was trained in podiatric medicine and surgery and spent several years in private practice. In 1999, Dr. Harris was awarded a Congressional Fellowship with the American Association for the Advancement of Science. She spent 1 year working in the U.S. Senate on many issues, including elder fraud, telemedicine, a national practitioners data bank, health professional shortage areas, stem cell research, and malpractice caps. While earning a master’s degree, she worked on various projects, including Medicaid disease management and the uninsured. She has a doctor of podiatric medicine degree from the Temple University School of Podiatric Medicine and a master of public health degree with a concentration in health policy from The George Washington University. Dianne Miller Wolman, M.G.A., most recently codirected a 3-year study on the consequences of uninsurance, which produced a series of six reports: Insuring Health. Before that she directed the study that resulted in the IOM report Medicare Laboratory Payment Policy: Now and in the Future, released in 2000. She joined the IOM’s Health Care Services Division in 1999 as a senior program officer. Her previous work experience in the health field was varied, focusing on finance and payment in insurance programs.
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Rewarding Provider Performance: Aligning Incentives in Medicare She previously worked for the General Accounting Office, where she was a senior evaluator on studies of HCFA and its management capacity. Previously, she was a policy specialist at a national association representing nonprofit providers of long-term care services. Prior to that she held positions in policy analysis and management with the office of the secretary, U.S. Department of Health and Human Services; with a peer review organization; with a governor’s task force on access to health care; and with a third-party administrator for very large health plans. In addition, she was policy director for a state Medicaid rate-setting commission. She holds a master’s degree in government administration from the Wharton Graduate School, University of Pennsylvania.