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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary Appendix D Speaker Biographies Gerard F. Anderson, Ph.D., is Professor of Health Policy and Management and Professor of International Health at the Johns Hopkins University Bloomberg School of Public Health, Professor of Medicine at the Johns Hopkins University School of Medicine, Director of the Johns Hopkins Center for Hospital Finance and Management, and co-Director of the Johns Hopkins Program for Medical Technology and Practice Assessment. Dr. Anderson is currently conducting research on chronic conditions, comparative insurance systems in developing countries, medical education, health care payment reform, and technology diffusion. He has directed reviews of healthcare systems for the World Bank and USAID in multiple countries. He has authored two books on healthcare payment policy, published over 200 peer-reviewed articles, testified in Congress over 40 times as an individual witness, and serves on multiple editorial committees. Prior to his arrival at Johns Hopkins, Dr. Anderson held various positions in the Office of the Secretary, U.S. Department of Health and Human Services, where he helped to develop Medicare prospective payment legislation. Joseph Antos, Ph.D., is Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute (AEI). He is also a Commissioner of the Maryland Health Services Cost Review Commission and an Adjunct Professor at the School of Public Health of the University of North Carolina at Chapel Hill. Prior to joining AEI, he was Assistant Director for Health and Human Resources at the Congressional Budget Office (CBO), and he held senior positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary the President’s Council of Economic Advisers. He also has extensive experience as an adviser to the U.S. Agency for International Development, the World Bank, and governments in Europe and Asia. Dr. Antos has written, lectured, and testified before Congress on the economics of health policy, including Medicare and broader health system reform, healthcare financing, health insurance regulation, and the uninsured. He is the editor, with Alice Rivlin, of Restoring Fiscal Sanity 2007: The Health Spending Challenge (Brookings Institution Press, 2007). He is past chairman of the Coalition for Health Services Research, a member of CBO’s panel of health advisers, and he serves on a variety of professional boards. He earned his Ph.D. in economics in 1974 from the University of Rochester, his M.A. in economics in 1971 from the University of Rochester, and his B.A. in mathematics from Cornell University in 1968. Michael Bailit, M.B.A., founded Bailit Health Purchasing, LLC in 1997 and has worked with a wide array of government agencies and purchasing coalitions across the United States since. His professional interests focus on how purchasers and regulators can influence healthcare markets to operate as effectively and efficiently as possible. Bailit has worked with clients on performance assessment activities, vendor management, chronic care model/medical home strategy design and implementation, reimbursement system design, and the use of incentives to motivate desired performance. His work has also included assistance with strategic planning activities for systems and programs. Prior to founding Bailit Health Purchasing, Bailit served as Assistant Commissioner for Benefit Plans in the Massachusetts Division of Medical Assistance, the state Medicaid agency. His responsibilities included the management of all of the Division’s benefit plans, including the HMO, behavioral health, primary care case management, and senior care programs. For each of these programs he designed and supervised the execution of procurements as well as ongoing vendor performance management. He was also responsible for new managed care program development for the Division, including the Division’s HCFA 1115 health reform waiver and its 1115 Medicare-Medicaid dual-eligible waiver. While with Massachusetts, he served as chair of the HCFA (now CMS) Medicaid Managed Care Technical Advisory Group. Also while with Massachusetts, Michael founded the Massachusetts Healthcare Purchaser Group and served as its chairman and president from 1993-1996. The MHPG is a statewide coalition of public and private purchasers of health insurance and is the leading voice of purchasers in the Commonwealth. Previously, Michael worked for Digital Equipment Corporation and was engaged in health and welfare benefit planning and management activities for Digital’s 60,000 U.S. employees. Michael earned a B.A. degree from Wesleyan University and earned an M.B.A. from the Kellogg School of Management at Northwestern University.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary John M. Bertko, F.S.A., MAAA, is currently Adjunct Staff at RAND, a Visiting Scholar at the Brookings Institution, and the retired Chief Actuary of Humana Inc., where he managed the corporate actuarial group and directed work by actuarial staff for Humana’s major business units, including developing Part D, Medicare Advantage, and consumer-driven health care products. He has extensive experience with risk adjustment and has served in several public policy advisory roles. He currently serves on the Medicare Payment Advisory Commission (MedPAC) and on the panel of health advisors for the Congressional Budget Office. He served the American Academy of Actuaries as a board member from 1994 to 1996 and as vice president for the health practice council from 1995 to 1996. He is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries. He has a B.S. in mathematics from Case Western Reserve University. Maureen Bisognano, M.S., is Executive Vice President and Chief Operating Officer of the Institute for Healthcare Improvement (IHI), an independent not-for-profit organization helping to lead the improvement of health care throughout the world. She is a prominent authority on improving healthcare systems, whose expertise has been recognized by her elected membership to the Institute of Medicine of the National Academy of Sciences and by her appointment to the Commonwealth Fund’s Commission on a High Performance Health System, among other distinctions. Ms. Bisognano advises healthcare leaders around the world, is a frequent speaker at major healthcare conferences on quality improvement, and is a tireless advocate for change. She is also an Instructor of Medicine at Harvard Medical School and a Research Associate in the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital. Prior to joining IHI, Ms. Bisognano was Senior Vice President of the Juran Institute, where she consulted with senior management on the implementation of total quality management in healthcare settings. Before that, she served as Chief Executive Officer of the Massachusetts Respiratory Hospital in Braintree, MA, where she implemented a hospital-wide strategic plan that improved the quality of care while simultaneously reducing costs. Ms. Bisognano began her career in health care in 1973 as a staff nurse at Quincy City Hospital. She was Director of Nursing at Quincy City Hospital from 1981 to 1982, Director of Patient Services from 1982 to 1986, and Chief Operating Officer from 1986 to 1987. She holds a B.S. degree from the State University of New York and an M.S. degree from Boston University. Randall R. Bovbjerg, J.D., is a Senior Fellow in the Health Policy Center of the Urban Institute. He has studied prevention of medical injury, tort reform, and non-judicial alternatives including medical discipline, along with many other topics in health policy, currently including state health reform
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary and the relevance of the Federal Employees Health Benefits program for national refom. His first health policy publication was a 1975 Duke Law Journal article on HMOs and malpractice. Most recently, he has coauthored a forthcoming paper on health reform cost containment, which has a section on liability reform. He also co-drafted chapter 6 of the Institute of Medicine’s 2000 book To Err Is Human and during 1992-1994 chaired the Advisory Panel on Defensive Medicine for the Office of Technology Assessment. He recently served on the Patient Safety Workgroup of the Federation of State Medical Boards and on JCAHO’s taskforce on alternatives to tort litigation. He has also taught at Duke and Johns Hopkins Universities and worked as a state insurance regulator in Massachusetts. Cory S, Capps, Ph.D., a Principal at Bates White, has more than 10 years experience as an economist specializing in industrial organization, empirical methods, and antitrust, with a focus on the healthcare industry. He has advised both private firms and government agencies on issues relating to hospital market power and competition, and he has experience analyzing joint ventures, group purchasing organizations, price-fixing and market allocation, and vertical foreclosure. Recently, Dr. Capps served as an outside expert in a Department of Justice investigation of a proposed merger in the healthcare sector. Prior to joining Bates White, Dr. Capps was a Staff Economist at the Antitrust Division of the Department of Justice (DOJ) where he concentrated in the analysis of competition in healthcare markets, including merger and civil nonmerger investigations of hospitals, physicians, nurses, insurers, home health agencies, and ambulatory surgery centers. While at the DOJ, he provided written testimony on geographic market definition before the DOJ/FTC Hearings on Healthcare Competition, Policy, and Law. And he provided oral testimony on for-profit and nonprofit hospital market power and pricing before the DOJ/FTC Hearings on Healthcare Competition, Policy, and Law. In addition to Dr. Capps’ broad healthcare experience, he has conducted economic analysis for investigations and cases involving a variety of industries such as airlines, semiconductors, newspapers, online content providers, and genetically modified crops. Dr. Capps has also provided economic consulting services to corporations on business and strategy issues. Dr. Capps’ academic career includes professorships at the University of Illinois at Urbana-Champaign and at Northwestern University’s Kellogg School of Management. He has published widely in journals including RAND Journal of Economics, Journal of Economics and Management Strategy, Journal of Health Economics, Antitrust Bulletin, Health Affairs, and Health Economics, Policy and Law. Lisa Carrara, has proven herself in a variety of underwriting, sales support, and product development management positions. She has been in
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary her current role as Head of Aexcel Product Development since July 2003. She also acquired responsibility for Group Insurance Product Development in mid-2005. Lisa began her career in a fast-track professional rotational development program where she had several assignments within medical claim as well as customer team financial underwriting. After several years in National Accounts Sales Support learning the complexities of selling managed care to jumbo accounts, she transitioned to a start-up opportunity managing Aetna’s first “24-hour” line of coverage, which combined non-occupational medical and group disability with workers’ compensation coverage. She moved to Aetna Group Insurance (life, disability, and longterm care) in 1996 where she assumed a number of management positions with increasing responsibility, including Proposal Unit Manager, Northeast Underwriting Director, Head of Key Accounts Underwriting, and Head of Product and Solutions Development until her final stop as Head of MultiChannel Distribution specializing in alternate distribution channels. Carrara has specialized in various start-up opportunities over her Aetna career. Specifically, the 24-hour product in National Accounts, the Group Insurance Proposal Unit, consolidation of Key Accounts segment for underwriting of renewals and presale activity, a focused Group Insurance Product Development team separate from the Product Management team, an entirely new business segment called Multi-Channel Distribution, and lastly, the Aexcel Network Product were all start-up business areas for Aetna. Lawrence Casalino, Ph.D., is Chief of the Division of Outcomes and Effectiveness Research in the Department of Public Health at Weill Cornell Medical College. Previously, he worked for 20 years as a family physician in private practice, obtained a Ph.D. in health services research at the University of California, Berkeley, and served as an Associate Professor at the University of Chicago. He is the recipient of an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation. Dr. Casalino studies the organization of physician practice, the use of organized processes to improve the quality of care, and physician relations with hospitals and health plans, as well as the public and private policies that influence physicians, hospitals, and health plans. Amitabh Chandra, Ph.D., is Professor of Public Policy at the Harvard Kennedy School of Government. He is a Research Fellow at the IZA Institute in Bonn, Germany, and at the National Bureau of Economic Research (NBER) in Cambridge, Massachusetts. His current research focuses on productivity and expenditure growth in health care, racial disparities in health care, and the economics of neonatal health and cardiovascular care. His research has been supported by the National Institute of Aging and the National Institute of Child Health and Development, and has been published in the American
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary Economic Review, the Journal of Political Economy, the Journal of Labor Economics, Journal of Policy Analysis and Management, Circulation, the American Heart Journal, and Health Affairs. He serves as an editor of the Journal of Human Resources, Economics Letters, and the American Economic Journal-Applied. He has been a faculty member at Dartmouth and MIT, and has been a consultant to the National Academy of Science, the Robert Wood Johnson Foundation, and the RAND Corporation. He is the recipient of an Outstanding Teacher Award, the first-prize recipient of the Upjohn Institute’s International Dissertation Research Award, the Kenneth Arrow Award for best paper in health economics, and the Eugene Garfield Award for the impact of medical research. Niteesh K. Choudhry, M.D., Ph.D., is Assistant Professor at Harvard Medical School and Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics and the Hospitalist Program at Brigham and Women’s Hospital. His research focuses on increasing the appropriate use of evidence-based medications for the treatment of common chronic conditions, such as coronary artery disease, hyperlipidemia, and diabetes, by reducing barriers to medication access and adherence. He is particularly interested in the impact of medication costs and financial incentives on medication use and is leading several randomized trials and large observational studies to explore these issues further. Dr. Choudhry attended McGill University and then received his M.D. and did his residency training in Internal Medicine at the University of Toronto. He served as Chief Medical Resident for the Toronto General and Toronto Western Hospitals and was later the Director of the Medical Clerkship Program at the Toronto General Hospital. He did his Ph.D. in health policy at Harvard University, with a concentration in statistics and the evaluative sciences, and was a Fellow in Pharmaceutical Policy Research at Harvard Medical School. Carolyn M. Clancy, M.D., is Director of the Agency for Healthcare Research and Quality (AHRQ). Prior to 2002, she was Director of the Agency’s Center for Outcomes and Effectiveness Research (COER). Dr. Clancy, a general internist and health services researcher, is a graduate of Boston College and the University of Massachusetts Medical School. Following clinical training in internal medicine, Dr. Clancy was a Henry J. Kaiser Family Foundation Fellow at the University of Pennsylvania. She was also an Assistant Professor in the Department of Internal Medicine at the Medical College of Virginia in Richmond before joining AHRQ in 1990. Dr. Clancy holds an academic appointment at George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine), is the Senior Associate Editor of Health Services Research and serves on multiple editorial boards (currently Annals of Family Medicine, American Journal
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary of Medical Quality, and Medical Care Research and Review). She has published widely in peer-reviewed journals and has edited or contributed to seven books. She is a member of the Institute of Medicine and was elected a Master of the American College of Physicians in 2004. David M. Cutler, Ph.D., has developed an impressive record of achievement in both academia and the public sector. He served as Assistant Professor of Economics from 1991 to 1995, was named John L. Loeb Associate Professor of Social Sciences in 1995, and received tenure in 1997. He is currently the Otto Eckstein Professor of Applied Economics in the Department of Economics and Kennedy School of Government and recently completed a 5-year term as Associate Dean of the Faculty of Arts and Sciences for Social Sciences. Honored for his scholarly work and singled out for outstanding mentorship of graduate students, Professor Cutler’s work in health economics and public economics has earned him significant academic and public acclaim. Professor Cutler served on the Council of Economic Advisers and the National Economic Council during the Clinton administration and was senior health care advisor to Barack Obama’s presidential campaign. Professor Cutler also advised the presidential campaign of Bill Bradley. Among other affiliations, Professor Cutler has held positions with the National Institutes of Health and the National Academy of Sciences. Currently, Professor Cutler is a Research Associate at the National Bureau of Economic Research and a member of the Institute of Medicine. Professor Cutler is the author of Your Money Or Your Life: Strong Medicine for America’s Health Care System, published by Oxford University Press. This book, and Professor Cutler’s ideas, were the subject of a feature article in the New York Times Magazine, The Quality Cure, by Roger Lowenstein. Cutler was recently named 1 of the 30 people who could have a powerful impact on health care by Modern Healthcare magazine and 1 of the 50 most influential men aged 45 and younger by Details magazine. Adam Darkins, M.B., Ch.B., M.D., MPHM, FRCS, leads the National Care Coordination/Telehealth Program within the U.S. Department of Veterans Affairs (VA). Care Coordination/Telehealth within VA involves the use of health informatics, telehealth, and disease management technologies to enhance and extend care and case management. Under his leadership, VA has developed the clinical, technological, and business underpinnings to successfully implement and sustain enterprise-wide telehealth-based services that improve access to care for patients, reduce utilization of healthcare resources, and are associated with very high levels of patient satisfaction. VA is seen as a national/international leader in telehealth with over 200,000 patients receiving care annually. The mission of these programs is to provide the right care in the right place at the right time to the appropriate patient.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary The associated aim is that of providing care for patients in the most convenient setting whenever safe, appropriate, effective, and cost-effective. The VA experience shows telehealth can bring about transformative change in the management of high incidence chronic diseases in the population, ones that pose an ever-increasing challenge for all healthcare systems. Darkins has worked in health services development using new information technologies in the United States and United Kingdom since 1991 and has a clinical background in neurosurgery. Nancy Davenport-Ennis, cancer survivor, is the Founder and Chief Executive Officer of two organizations she founded in 1996, National Patient Advocate Foundation (NPAF), a policy organization, headquartered in Washington, DC, that seeks to improve access to care through regulatory and policy initiatives at the state and federal levels and Patient Advocate Foundation (PAF), a 501(c)3 direct patient services non-profit organization, headquartered in Newport News, Virginia, that provides professional case management services to insured, under-insured, and un-insured patients diagnosed with chronic, debilitating, and life-threatening conditions. PAF also has an office in Mission Valley, California and home office case management support in Iowa, Tennessee, Nevada, and New York. Davenport-Ennis was recently appointed by the Agency for Healthcare Research and Quality to serve on the Centers for Education and Research on Therapeutics (CERTs) Committee. She was also appointed by the National Institutes of Health to serve on its Open Ended Working Group (OEWG). In the past, she has been appointed to, or has served on, several national committees including an appointment by the United States Secretary of Health and Human Services as a Commissioner on the American Health Information Community (AHIC), with Health and Human Services (HHS) serving as Co-Chair of the Consumer Empowerment Working Group for AHIC, Directors Consumer Liaison Group (DCLG) with the National Cancer Institute (NCI), a voting seat on the Medicare Coverage Advisory Committee (MCAC) at the Centers for Medicare & Medicaid Services, Access to Quality Cancer Care Team, a committee of C-Change, One Voice Against Cancer, Virginia Governor’s Government & Regulatory Reform Task Force, Virginia Attorney General’s Regulatory and Government Reform Task Force-Healthcare Working Group, Health Information Technology Council for Virginia, and the Mayor’s Committee on Medicaid and Physician Recruitment in Newport News, VA. Ms. Davenport-Ennis is the recipient of the 2005 Women in Business Achievement Award presented by Anthem and Business Week. Davenport-Ennis was honored with the 1989 Outstanding Young Woman of America Award, the Association of Community Cancer Centers Advocate of the Year Award, and the U.S. Oncology Medal of Honor Award. Ms. Davenport-Ennis was also appointed to the Governor’s Commission
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary on the Uninsured in Virginia. Davenport-Ennis was also named as a Paul Harris Fellow by the National Rotary Foundation. Davenport-Ennis holds a B.A. degree in English from Campbell University. She resides in Yorktown, Virginia with her husband, John H. Ennis, Jr. and has two daughters and four grandchildren. Karen Davis, Ph.D., is President of the Commonwealth Fund, a national philanthropy engaged in health and social policy research. Previously, she served as Chairman of the Department of Health Policy and Management at the Johns Hopkins School of Public Health, where she was also a Professor of Economics. She was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1977-1980. Prior to that, she was a Senior Fellow at the Brookings Institution, a Visiting Scholar at Harvard University, and an Assistant Professor of Economics at Rice University. Among many other honors and awards, Dr. Davis received the AcademyHealth Distinguished Investigator Award in 2006 and was honored by the Institute of Medicine with the Adam Yarmolinsky Medal in 2007. She is on the board of directors of the Geisinger Health System and serves on the Panel of Health Advisors for the Congressional Budget Office. Wendy Everett, Sc.D., plays a leading role in creating NEHI’s lasting partnerships with other successful national health policy organizations. As President, she works with the board to create NEHI’s vision and strategy, and to communicate it to the outside world. She also provides direction and oversight for NEHI’s many reports and initiatives. Dr. Everett was appointed as the first President of the New England Healthcare Institute (NEHI) in July 2002. With over 30 years of experience in the healthcare field, Dr. Everett brings a unique perspective to NEHI. She has held executive positions at the University of California, San Francisco (UCSF) Medical Center and at Brigham and Women’s Hospital in Boston. In the 1980s, she directed a national demonstration program for the Robert Wood Johnson Foundation and subsequently was the Program Director for the National Program in Health Promotion and Disease Prevention for the Kaiser Family Foundation. She has served as a consultant to many state and national philanthropic foundations. In the mid 1990s, she became a Director of the Institute for the Future, leading the Health and Health Care research team for 6 years and overseeing the creation of 10-year, national forecasts in health/health care. She is a Trustee of many health care and philanthropic boards. Dr. Everett holds two bachelor of science degrees and master’s and doctoral degrees in health policy and management from Harvard University.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary Roger Feldman, Ph.D., is the Blue Cross Professor of Health Insurance and Professor of Economics at the University of Minnesota. Dr. Feldman was a Marshall Scholar at the London School of Economics and holds a Ph.D. in economics from the University of Rochester. His research examines the organization, financing, and delivery of health care with a focus on health insurance and competition. He also studies competition among healthcare providers and insurers. Currently, he is evaluating the effect of consumer-directed health plans on medical care utilization and personal savings decisions. Dr. Feldman’s experience in healthcare policy includes serving on the Senior Staff of the President’s Council of Economic Advisers, where he was the lead author of a chapter in the 1985 Economic Report of the President. From 1988 to 1992, he directed one of the four national research centers sponsored by the Centers for Medicare & Medicaid Services (CMS). He advised CMS on the design of a demonstration of competitive pricing for Medicare health plans and is evaluating the competitive pricing program for durable medical equipment in Medicare. Dr. Feldman is a regular contributor to journals of economics and health services research. He has advised government agencies and has been a consultant to federal and state antitrust agencies. His research has received four “best paper” awards from the Association for Health Services Research and the National Institute for Health Care Management. Timothy G. Ferris, M.D., M.P.H., is a practicing general internist and pediatrician and the medical director of the Mass General Physicians Organization. He is formally the Vice Chair for Quality for Partners Pediatrics and Mass General Hospital for Children. He is also a Senior Scientist in the Partners/MGH Institute for Health Policy and an Associate Professor of Medicine at Harvard Medical School. His research has focused on the measurement and improvement of healthcare quality for adults and children, particularly focused on the roles of financing and health information technology. In addition to quality improvement interventions, he has published studies on the effects of the organization and financing of care on the costs and quality of care, risk adjustment of quality measures, and disparities in health care. He has over 50 publications including those in journals such as the New England Journal of Medicine, JAMA, Pediatrics, and Health Affairs. Dr. Ferris has been leading efforts at Partners Healthcare to improve the care of patients with multiple chronic conditions with specific responsibility for design, oversight, and evaluation of programs to improve quality and efficiency of care for high-risk patients such as those with heart failure. Dr. Ferris has been a member of the Agency for Healthcare Research and Quality’s Health Care Quality and Effectiveness Research study section, has chaired two Technical Advisory Panels for the National Quality Forum, sits on the Quality and Safety subcommittee to the Board of the National As-
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary sociation of Children’s Hospitals and Related Institutions (NACHRI), and consulted to the World Health Organization. Elliott S. Fisher, M.D., M.P.H., is Professor of Medicine and Community and Family Medicine at the Dartmouth Medical School, and Director of Health Policy Research at Dartmouth’s Center for the Evaluative Clinical Sciences. He is also Co-Director of the VA Outcomes Group, a research and training program for physicians, at the Department of Veterans Affairs Medical Center in White River Junction, Vermont. Dr. Fisher received his A.B. from Harvard University, his M.D. from Harvard Medical School, and his M.P.H. from the University of Washington. Dr. Fisher has broad expertise in the use of Medicare databases and survey research methods for health system evaluation. His research interests lie in three areas: (1) he has worked to clarify the limitations of administrative databases and develop methods to overcome them; (2) he has also developed approaches to resource allocation based upon the principles of benchmarking, initially as a means of addressing inequities in the levels of hospital resources across communities in Oregon and more recently as applied to the U.S. physician supply; (3) most recently, he has focused on the health implications of the uneven distribution of healthcare resources. His current research, funded by the Robert Wood Johnson Foundation, examines the potential adverse consequences of increasing capacity in health care. Dr. Fisher publishes in professional journals such as the Journal of the American Medical Association and the New England Journal of Medicine. Some of his more recent publications include Variations in the Longitudinal Efficiency of Academic Medical Centers, Health Affairs, 2004; and The Implications of Regional Variations in Medicare Spending, Annals of Internal Medicine, 2003. Thomas J. Flottemesch, Ph.D., is a Research Associate at HealthPartners Research Foundation with advanced degrees in economics and statistics. His particular areas of expertise are cost effectiveness analysis, econometric methods, operations/decision modeling, and health information technology. For the past 5 years, Dr. Flottemesch has worked on the Prevention Priorities Project where he has led construction of cost-effectiveness models of obesity prevention, dietary interventions, and cervical cancer and colorectal cancer screening. In addition, he has conducted econometrics analyses of tobacco use, dental care, hospital costs, chronic disease care, and patient-centered medical home (PCMH) implementation. Dr. Flottemesch has also served as consultant to hospitals where he has applied sophisticated decision support models to assess patient flow and hospital staffing patterns and has interfaced these models with existing HIT systems. These findings were presented at a didactic session of the Society of Academic Emergency Medicine’s annual meeting. His current interests are in the areas of model-
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary University. He was Chair of the Department of Economics at Vanderbilt from 1986 to 1989. His current research interests include alcohol use and smoking prevention, long-term care, medical malpractice, and costeffectiveness analyses of medical technologies. He also has a long-standing interest in hospitals, including regulation of hospitals, healthcare financing, and health manpower. He has served on several national advisory public and private groups. He is a member of the Institute of Medicine and was formally a member of the Physician Payment Review Commission. He is the author of about 300 journal articles and book chapters and has co-authored and co-edited about 20 books. Recently published books are Medical Malpractice (MIT Press, 2008, coauthored with L. Chepke) and Incentives and Choice in Health Care (MIT Press, 2008, co-edited with H. Kasper). Peter K. Smith, M.D., is Professor and Chief of Cardiothoracic Surgery at Duke University. He is a graduate of Princeton University (Phi Beta Kappa), Duke Medical School (AOA), and of the Duke General Surgery and Thoracic Surgery residencies. He has received the AHA Clinician Scientist Award, an NIH Research Career Development Award, and is currently the Duke PI in the NHLBI Cardiac Surgery Research Network. He has authored or coauthored 140 peer-reviewed publications. He has a long-standing interest in clinical databases and has managed the Duke Cardiac Surgery clinical database since 1987, collaborating with the STS National Cardiac Database since its inception. His most recent work has focused on comparative effectiveness of PCI and CABG and he is the surgeon member of the AHA/ACC Appropriateness Criteria Writing Committee. He has pioneered the use of clinical databases to improve the accuracy of the Medicare Physician Fee Schedule as the thoracic surgery member of the AMA Relative Value Update Committee (RUC). For this work, he received the Distinguished Service Award of the Society of Thoracic Surgeons in 2006. Steven J. Spear, D.B.A., M.S., is author of the award-winning and critically acclaimed book, Chasing the Rabbit: How Market Leaders Outdistance the Competition. A Senior Lecturer at the Massachusetts Institute of Technology and a Senior Fellow at the Institute for Healthcare Improvement, Spear is internationally known for his expertise in innovation, operational excellence, and organizational learning, with deep expertise in industry and health care, based, in part on his 1999 Harvard Business Review article, Decoding the DNA of the Toyota Production System, and his 2005 article, Fixing Healthcare from the Inside, Today, which was an HBR McKinsey Award winner and one of his five works to win a Shingo Research Prize. Spear helped develop and deploy the Alcoa Business System in the late 1990s and the Pittsburgh Regional Healthcare Initiative’s “Perfecting Patient Care” a few year’s after. He has worked with several other leading
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary academic medical centers, and he is on a patient safety advisory panel for Beth Israel Deaconess Medical Center in Boston. Other clients have included Intel, Lockheed Martin, and Intuit, and he collaborates actively with Toyota and its North American suppliers. Spear has published in the New York Times, the Boston Globe, Annals of Internal Medicine, and Academic Medicine, and he has spoken to audiences ranging from the Association for Manufacturing Excellence to the Institute of Medicine. His degrees include a doctorate from Harvard Business School, Master’s in engineering and in management from MIT, and a Bachelor’s degree in economics from Princeton. Glenn Steele, Jr., M.D., Ph.D., is President and Chief Executive Officer of Geisinger Health System. Dr. Steele previously served as the Dean of the Biological Sciences Division and the Pritzker School of Medicine and as Vice President for Medical Affairs at the University of Chicago, as well as the Richard T. Crane Professor in the Department of Surgery. Prior to that, he was the William V. McDermott Professor of Surgery at Harvard Medical School, President and Chief Executive Officer of Deaconess Professional Practice Group, Boston, Massachusetts, and Chairman of the Department of Surgery at New England Deaconess Hospital (Boston, Massachusetts). Widely recognized for his investigations into the treatment of primary and metastatic liver cancer and colorectal cancer surgery, Dr. Steele is past Chairman of the American Board of Surgery. He serves on the editorial board of numerous prominent medical journals. His investigations have focused on the cell biology of gastrointestinal cancer and pre-cancer and most recently on innovations in healthcare delivery and financing. A prolific writer, he is the author or co-author of more than 460 scientific and professional articles. He is a member of the Institute of Medicine of the National Academy of Sciences and serves on their Committee on Reviewing Evidence to Identify Highly Effective Clinical Services (HECS), the New England Surgical Society, a fellow of the American College of Surgeons, the American Surgical Association, the American Society of Clinical Oncology, and past President of the Society of Surgical Oncology. He was a member of the National Advisory Committee for Rural Health, and the Pennsylvania Cancer Control Consortium and is presently a member of the Healthcare Executives Network, the Alliance for Advancing Non-profit Health Care, the Commonwealth Fund’s Commission on a High Performance Health System, and the National Committee for Quality Assurance’s (NCQA) Committee on Performance Measurement. In addition, Dr. Steele was Chair for the American Hospital Association Systems Governing Council and now serves on the AHA Long-Range Policy Committee. He is currently Honorary Chair of the Pennsylvania March of Dimes Prematurity Cam-
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary paign. Dr. Steele serves on several boards including Bucknell University’s Board of Trustees, Temple University School of Medicine’s Board of Visitors, the American Hospital Association’s Board of Trustees, Premier, Inc., the Healthcare Financial Management Association’s Healthcare Leadership Council, the HFMA Healthcare Leadership Council, the Northeast Regional Cancer Institute, the Global Conference Institute, and previously served on the Simon School of Business Advisory Board (University of Rochester) 2002-2007. In 2006, Dr. Steele received the CEO IT Achievement Award, given by Modern Healthcare and the Healthcare Information and Management Systems Society (HIMSS) for promoting health information technology. In 2007, Dr. Steele received AHA’s Grassroots Champion Award and was named to Modern Healthcare’s 50 Most Powerful Physician Executives in Healthcare. Jennifer Sweeney, M.A., is the Director of Americans for Quality Health Care, a project of the National Partnership for Women & Families. Funded by the Robert Wood Johnson Foundation, Americans for Quality Health Care promotes consumer involvement in the drive to improve heathcare quality and increase transparency. Sweeney sits on the Center for Medical Technology’s Patient Consumer Advisory Committee, AHRQ’s TalkingQuality Web site editorial board, and the Consumers United for Evidence-Based Healthcare steering committee. Prior to joining the National Partnership for Women and Families, Sweeney was the Director of Public Policy at Business and Professional Women/USA. As the organization’s top policy advisor, she worked to advance BPW/USA’s agenda on Capitol Hill, throughout the executive branch, and in coalition with partners from the business, women’s, and civil rights communities. She was also responsible for coordinating BPW/USA’s grassroots campaigns and facilitating BPW/PAC’s campaign contributions and endorsements. Before joining Business and Professional Women/USA, Sweeney was a Senior State Lobbyist with the American College of Obstetricians and Gynecologists (ACOG), the nation’s leading group of professionals providing health care for women. While at ACOG, Sweeney led a successful campaign to increase the number of states with contraceptive equity laws. Prior to her work at ACOG, Sweeney was a Senior Research Consultant with the Corporate Executive Board, where she conducted “best-practice” benchmarking research on gender and diversity issues for Fortune 500 companies. Sweeney received a B.A. in English from Union College and an M.A. in women’s studies from the George Washington University. Sweeney has been active in the Women’s Information Network, Women in Government Relations, and Toastmasters International. She is the former Foundation Chair for the George Washington University’s Women’s Studies Endowment.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary Robin J. Thomashauer, M.H.S.A., is Executive Director of CAQH, an unprecedented nonprofit alliance of health plans and trade associations that serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration. Established in 2000, the organization promotes streamlined interactions between health plans, providers, and other stakeholders; reduces costs and frustrations associated with healthcare administration; and facilitates administrative healthcare information exchange. Ms. Thomashauer has overall responsibility for CAQH strategy, operations, and membership. She brings more than 30 years of experience in managed care operations and hospital administration, including responsibility for a broad range of operating and staff functions. Before joining CAQH, she was a Director in the health care practice at PricewaterhouseCoopers (PwC), with a primary focus on payer organizations. Prior to her position with PwC, Ms. Thomashauer held senior management positions with Kaiser Permanente, as well as in several teaching hospitals. Ms. Thomashauer holds an M.H.S.A. in hospital administration from the George Washington University, and a B.A. in social sciences from Colgate University. She is a Diplomate in the American College of Healthcare Executives and serves on the Adventist HealthCare Board of Trustees. Kenneth E. Thorpe, Ph.D., is the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality. He was the Vanselow Professor of Health Policy and Director, Institute for Health Services Research at Tulane University. He was previously Professor of Health Policy and Administration at the University of North Carolina at Chapel Hill, an Associate Professor and Director of the Program on Health Care Financing and Insurance at the Harvard University School of Public Health, and Assistant Professor of Public Policy and Public Health at Columbia University. Dr. Thorpe has also held visiting faculty positions at Pepperdine University and Duke University. Professor Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. In this capacity, he coordinated all financial estimates and program impacts of President Clinton’s healthcare reform proposals for the White House. He also directed the administration’s estimation efforts in dealing with congressional healthcare reform proposals during the 103rd and 104th sessions of Congress. As an academic, he has testified before several committees in the U.S. Senate and House on healthcare reform and insurance issues. In 1991, Professor Thorpe was awarded the Young Investigator Award presented to the most promising health services researcher in the country under age 40 by the Association for Health Services Research. He also received the Hettleman Award for academic and scholarly research
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary at the University of North Carolina and was provided an “Up and Comers” award by Modern Healthcare. N. Marcus Thygeson, M.D., serves as Vice President and Medical Director for Consumer Health Solutions. Thygeson works closely in partnership with the leadership of Sales and Account Services, Customer Service and Product Development, as well as Health, Medical, and Network Management, to help translate key account trends and requirements into product, service, and other solutions. Thygeson is also a Senior Fellow at the HealthPartners Research Foundation and is currently engaged in a Bush Medical Fellowship exploring the application of complex systems science to healthcare improvement, with a particular focus on reducing overuse and misuse and promoting affordability. Prior to joining HealthPartners, Thygeson served as the Medical Director for Definity Health; he was responsible for personal care support strategy and operations, and supporting consumer activation, network strategy, and provider relations. Prior to joining Definity Health, Thygeson was the Chief Medical Officer of Mywayhealth, another consumer driven healthcare benefit plan. Before Mywayhealth, Thygeson held a number of medical management positions at Alta Bates Medical Center, in Berkeley, California, and served from 1996 to 2000 as the Medical Director from Alta Bates Medical Group, an award-winning California IPA. He is board certified in internal medicine and gastroenterology. Thygeson received his B.S. summa cum laude from the University of California at Davis, and is a graduate of Harvard Medical School. He received his medical training at Virginia Mason Hospital, where he was Chief Medical Resident, and at the University of California San Francisco. John Toussaint, M.D., Founder and President of the ThedaCare Center for Value in Healthcare, has the experience and passion to be a driving force in creating healthcare value. From 2000-2008, Dr. Toussaint served as President and Chief Executive Officer of ThedaCare, Inc., a community-owned, four-hospital health system including 21 physician clinics, as well as home health capabilities, senior care facilities, hospice care, and behavioral health. ThedaCare is the largest employer in Northeast Wisconsin with nearly 5,400 employees, serving an eight-county region. During his tenure as President and CEO of ThedaCare, Dr. Toussaint introduced the ThedaCare Improvement System (TIS), which is derived from the Toyota Production system. This model of continuous improvement helped save millions of dollars in healthcare costs by reducing patient errors, improving outcomes, and delivering better quality care at a higher value. Presently, he is 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
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary state. In 2005, Dr. Toussaint was appointed to the Institute of Medicine’s Committee on Pay for Performance for Physicians, as well as to Governor Doyle’s e-Health and Patient Safety Board. ThedaCare and Dr. Toussaint’s work have been featured in the Wall Street Journal, Modern Healthcare, the Harvard Business Review, and Health Management Technology. Additionally, Dr. Toussaint is asked to speak all over the world on lean and the topics of quality and efficiency in healthcare. He recently was a keynote speaker at the fourth annual Australasian Redesigning Health Care Summit in Melbourne, Australia. He also spoke at the Lean Healthcare Conference organized by the National Healthcare Group in Singapore. In October 2008, Toussaint spoke at the Association for Manufacturing Excellence’s (AME) International Lean Conference in Toronto on the topic of “Innovation Using Lean in Healthcare.” Sandeep Green Vaswani, M.B.A., is a Senior Vice President with the Institute for Healthcare Optimization. In this role, Vaswani is responsible for new program development, management of various hospital flow improvement initiatives, and development of software tools. He is the lead author of a chapter (Strategies to Manage Patient Flow) in Joint Commission’s upcoming book on patient flow management. Vaswani has wide ranging experience in hospital strategy, finance, operations, and data-driven business management. Since the fall of 2007, Vaswani has been working on various operating room redesign and patient flow initiatives with Dr. Eugene Litvak and Boston University’s Program for the Management of Variability in Healthcare Delivery. Previously, Vaswani served as Director, Analysis & Planning at the Brigham and Women’s Hospital in Boston, establishing the department within their Center for Clinical Excellence. In that role, Vaswani served as an advisor to the hospital executive team. He oversaw strategic and business planning, departmental multi-year planning, cost benchmarking, and the development of capacity utilization and projection models. He played a broad role in the development of the hospital’s new cardiovascular center, including strategy planning, financial analysis, board approval process, architectural design and development, and operational planning. Along with his team, Vaswani led the development of models to assess and project the utilization of hospital capacity such as the operating rooms, inpatient beds, emergency room, cath lab, interventional radiology, outpatient clinics, and endoscopy. This initiative led to an institutionwide focus on enhancement of utilization of existing hospital assets. Prior to Brigham and Women’s Hospital, Vaswani worked in a variety of settings—management consulting with the strategy-consulting firm Monitor Company, equity research and investment banking in Bombay, India and New York, and product management for a television manufacturer in India. Vaswani has an undergraduate degree in electronics engineering from
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary Bombay University, and an M.B.A. from the Stern School of Business at New York University. David Wennberg, M.D., M.P.H., is an internist with specialty training in health services and outcomes research. He currently serves as Chief Science & Products Officer of Heath Dialog. Prior to this role, he co-founded Health Dialog Analytic Solutions (HDAS), the analytics division of Health Dialog, which he continues to oversee. In addition to his role at Health Dialog, Dr. Wennberg is a member of the Primary Project Team of the Dartmouth Atlas Working Group at the Dartmouth Institute for Health Policy and Clinical Practice. He also served as the Director of the Center for Outcomes Research & Evaluation at the Maine Medical Center, focusing on the drivers of utilization and quality in the delivery of healthcare services. Dr. Wennberg earned his medical degree from McGill University Faculty of Medicine and his M.P.H. from Harvard School of Public Health. Dr. Wennberg has published extensively, including in the New England Journal of Medicine, Annals of Internal Medicine, and the Journal of the American Medical Association, and is an internationally recognized authority on the root causes of unwarranted variation. David S. Wichmann, joined UnitedHealth Group in 1998 and has assumed the position of Executive Vice President, UnitedHealth Group and President, UnitedHealth Group Operations. He previously held positions at UnitedHealth Group as President, Commercial Markets Group; President and Chief Operating Officer, UnitedHealthcare; President and Chief Executive Officer, Specialized Care Services; and Senior Vice President, Corporate Development. Prior to joining UnitedHealth Group in 1998, Mr. Wichmann was a partner with Arthur Andersen. Mr. Wichmann is a board member of the YMCA of Metropolitan Minneapolis, the Minnesota Orchestral Association, Sedgwick CMS, and the UnitedHealthcare Children’s Foundation. Andrew M. Wiesenthal, M.D., S.M., is Associate Executive Director for Clinical Information Support for the Permanente Federation. From 1983 until 2000, Dr. Wiesenthal served as a pediatrician and pediatric infectious disease consultant with the Colorado Permanente Medical Group (CPMG). He also led CPMG’s quality management program and served as Associate Medical Director for Medical Management, with responsibility for quality management, utilization management, regulatory compliance, risk management, credentialing and physician performance, and informatics. His current work is in the arenas of development and deployment of automated medical records, decision support, and other clinical systems for all of Kaiser Permanente. He graduated from Yale University with a B.A. degree (with honors) in Latin American Studies in 1971 and received his medical
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary degree in 1975 from the State University of New York, Downstate Medical Center in Brooklyn. He completed his pediatric residency at the University of Colorado in 1978, and then served as an Epidemic Intelligence Service Officer with the Centers for Disease Control from 1978 to 1980 before returning to the University of Colorado for a pediatric infectious disease fellowship, which he completed in 1983. In 2004, he earned an S.M. in health care. Steven H. Woolf, M.D., M.P.H., is Professor in the Departments of Family Medicine, Epidemiology, and Community Health at Virginia Commonwealth University and is Director of the VCU Center on Human Needs. He received his M.D. in 1984 from Emory University and underwent residency training in family medicine at Virginia Commonwealth University. Dr. Woolf is also a clinical epidemiologist and underwent training in preventive medicine and public health at Johns Hopkins University, where he received his M.P.H. in 1987. He is board certified in family medicine and in preventive medicine and public health. Dr. Woolf has published more than 150 articles in a career that has focused on evidence-based medicine and the development of evidence-based clinical practice guidelines, with a special focus on preventive medicine, cancer screening, quality improvement, and social justice. From 1987 to 2002, he served as science advisor to, and then member of, the U.S. Preventive Services Task Force. Dr. Woolf edited the first two editions of the Guide to Clinical Preventive Services and is author of Health Promotion and Disease Prevention in Clinical Practice. He is associate editor of the American Journal of Preventive Medicine and served as North American editor of the British Medical Journal. He has consulted widely on various matters of health policy with government agencies and professional organizations in the United States and Europe, and in 2001 was elected to the Institute of Medicine. Mark E. Wynn, Ph.D., is a Senior Analyst in the Division of Payment Policy Demonstrations at the Centers for Medicare & Medicaid Services (CMS). That division is responsible for operating payment demonstrations in the fee-for-service original Medicare program. Mr. Wynn has directly managed or supervised a series of demonstrations for the Medicare program, including: bidding for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in Polk County, FL and San Antonio, TX; bidding for clinical laboratory services in San Diego, CA; gainsharing at acute care hospitals; value based purchasing and pay for performance in several settings, including the Premier Hospital Quality Incentive Demonstration and the Nursing Home Value Based Purchasing Demonstration; global payments in acute care hospitals, including the Acute Care Episode (ACE) Demonstration; support for small rural hospitals, in two demonstrations
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary that led to the Critical Access Hospital (CAH) Program; and the development of Ambulatory Patient Groups (APGs). Wynn has a Ph.D. in political science, specializing in public policy, from Northwestern University, and has been with the Medicare program since 1987. He was an APSA Congressional Fellow in the 1990s, and worked in the offices of U.S. Senator Max Baucus and (then) Congressman Ben Cardin. Prior to joining the Medicare program, Wynn worked in the Office of Policy, Development, and Research at HUD and taught political science at Lake Forest College and at the University of Wisconsin-Whitewater.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary