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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Dartmouth Atlas: Elliot Fisher for HHS Secretary

Atlas (ăt‘ləs) n.

  1. A book or bound collection of maps, sometimes with supplementary illustrations and graphic analyses.
  2. A volume of tables, charts, or plates that systematically illustrates a particular subject

I have some reservations about Kathleen Sebelius being appointed to the new role of HHS Secretary. She certainly possess the requisite leadership, experience, and other criteria that would appear on paper to make her an excellent candidate. But I am not worried about whats on her resume, I am worried about what’s in her head.  Coming from an insurance background, I am concerned that she will be mired in the managed care thinking of the insurance world she grew up in, the bureacratic complexities of the CPT/ICD-9 coding world, and the perverse incentives and lack of system accountability in our current Fee For Service / RUC focused payment paradigm.

A far better choice in my opinion would have been Dr. Elliott Fisher of Dartmouth Atlas fame. During my 8 hours of traffic school torture, I was finally able to read through their December publication called “Improving Quality and Curbing Health Care Spending: Opportunities for Congress and the Obama Administration“.  I was once again struck by the quality of their work, the compelling nature of the findings, and their lucid “Agenda for Change”. I love the Dartmouth Group because they are all about the DATA – and they have it in spades –  and it paints a picture that is not so pretty. Unwarranted, unbelievable, and ultimately unacceptable variations in care, in cost, and quality persist across our country.  I would highly recommend reading and understanding their work if you want to be a meaningful contributor to any upcoming health care reform conversations.

This paper focuses on the issues related to supply-sensitive demand, or more simply put, the unnerving fact that as more health care capacity is added, health care cost go up and quality of care goes down. In fact, the argue vigorously that we already have enough hospitals, delivery networks, and even physicians to more than handle our current health care load. They strongly and persuasively argue that we actually need for a much “simpler” health care system:

“It is vital to both patients and the American economy that we curb overuse, rational supply of medical resources, promote organized care, and improve the scientific basis off clinical decision making. Since Medicare spends most of tis dollars on the chronically ill in acute care hospitals reducing the overuse of acute care hospital would substantially cut Medicare spending, and improve both geographic equity and financial consequences to patients.”

“Congress, CMS, and the Administration should focus a significant part of reform efforts on expanding organized care. This is the fastest way to achieve the goals of increased efficiency, higher quality, and better outcomes. We urge the Congress and the new administration to push forward with a coordinated, multi-pronged strategy for health care reform that includes the methods outlined her for reducing unwarranted variation, expanding organized care systems, and improving quality. The health and wealth of our nation depend upon it.”

Elliot Fisher has been singing this song, alongside John Wennberg, for 15-20 years. They have accumulated an extraordinary body of research, compelling insights into the root cause of unwarranted variations, and now with this paper (and their ongoing work) a vision for how we can move to a next generation health care system. Having Elliot influencing our national health care agenda could accelerate both the pace and probability that we can achieve this vision of health.

2 comments on “Dartmouth Atlas: Elliot Fisher for HHS Secretary

  1. John Adler says:

    If the system becomes fixated on “reducing unwanted variation” where will innovation come from? As a clinical innovator I think it is becoming reasonable to envision a future of medicine devoid of all progress other than improved “processes” for outpatient management of diabetes and HTN. If you think my sentiments are needly pessimistic, I challenge anyone to find any experienced clinical innovators who feel otherwise.

    1. John,

      Thanks for your comment. I was surprised by your comment regarding “reducing unwanted variation”. It is a clever word play that is entirely incorrect. You realize, of course, the term is actually “reducing UNWARRANTED variation”. If that term is unfamiliar with you I would recommend that you read the excellent article by Atul Gawande, MD that meticulously lays out the problem.

      I am a clinical innovator who is attempting to crush this unjustified use of medical resources (unjustified because they do not produce better outcomes and cost more). I will use INNOVATION to catalyze the transformation that must occur within American Medicine. There are plenty of other innovators – like Virginia Mason, Mayo Clinic, Geisinger Health System, and Kaiser – who have all demonstrated through the intelligent use of technology, process redesign, and care delivery innovation that we can attain dramatically better results for significantly less cost thus improving health care value.

      Be happy to discuss further with you in person.

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