Elliott S. Fisher

For nearly 20 years, The Dartmouth Atlas of Health Care has documented remarkable variations in clinical practice and health care spending across the United States – with greater than five fold differences in rates of common surgical procedures and two-fold differences in mortality rates and per-capita spending. The research demonstrating that higher spending or greater utilization rates were not associated with better quality or outcomes not only helped motivate health care reform, but also provided the insights about what principles should guide reform: (1) ensuring that when the evidence about benefit is unequivocal, health systems should achieve high levels of reliability in delivering these evidence-based services (doing the right thing right); (2) ensuring that when tradeoffs are involved (as in most clinical decisions), patients’ well-informed preferences must guide treatment choices (doing the right thing for the right patient); (3) ensuring that payment and delivery models are aligned to enable providers to improve care and lower costs (doing the right thing, and no more). Dr. Fisher is one of the founders of the Dartmouth Atlas and remains active in its leadership. Insights from this presentation will be useful to clinicians, health system leaders and others interested in advancing their understanding of the remarkable opportunities to improve the performance of health systems in the US and across the globe.