John Wennberg

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John E. "Jack" Wennberg, MD, MPH is the pioneer and leading researcher of unwarranted variation in the healthcare industry. Through four decades of work, Dr. Wennberg has documented the geographic variation in the healthcare that patients in the United States receive. In 1988 he founded the Center for Evaluative Clinical Services (CECS) at Dartmouth Medical School, which works directly with Health Dialog to address this unwarranted variation in healthcare. He currently holds the Peggy Y. Thomson Chair for the Evaluative Clinical Sciences at Dartmouth and has been Professor in the Department of Community and Family Medicine since 1980 and in the Department of Medicine since 1989. Together with his CECS colleagues, Wennberg has produced the Dartmouth Atlas of Health Care, a series of reports on how health care is used and distributed in the United States. In June of 2007, Wennberg stepped down as director of the CECS, now known as the Dartmouth Institute for Health Policy And Clinical Practice (TDI).^[1]

Contents 1 Biography 2 Work in Unwarranted Variation 3 Health Dialog 4 Lowering Medicare Costs 5 Awards 6 Publications 7 References 8 External links

[edit] Biography

Dr. Wennberg is a member of the Institute of Medicine of the National Academy of Sciences and of the Johns Hopkins University Society of Scholars. Dr. Wennberg is a graduate of Stanford University and the McGill University Faculty of Medicine. His postgraduate training was in internal medicine and nephrology at Johns Hopkins, but he became interested in the application of epidemiological principles to the health care system while pursuing his master’s degree in Public Health at Johns Hopkins.

He cofounded the Foundation for Informed Medical Decision Making in Hanover, New Hampshire, a nonprofit corporation that provides objective scientific information to patients about their treatment choices using interactive media.

Dr. Wennberg is Principal Investigator and Series Editor of The Dartmouth Atlas of Health Care, which examines the patterns of medical resource intensity and utilization in the United States. The Atlas project also has reported on patterns of end-of-life care, inequities in the Medicare reimbursement system, and the underuse of preventive care.^[2]

“When Jack started his work, geographic variation in health care -- and the resulting variation in health care costs -- was largely unknown and unremarked upon,” said Health Affairs founding editor John Iglehart, who presented an award from the journal to Wennberg. “But thanks to Jack’s persistence, the idea that the care you receive is largely determined by where you live -- and not necessarily by what is most appropriate for you -- has become part of the common parlance of health policy.”

Indeed, Wennberg’s work has shown that areas that spend more and provide more services often experience worse outcomes than lower-spending areas that provide less intensive care. In a 2002 Health Affairs article, Wennberg proposed a Medicare reform plan based on reducing unwarranted regional variations in spending by the program. In the latest Dartmouth Atlas, Wennberg and colleagues state that “the Medicare system could reduce spending by at least 30 percent while improving the medical care of the most severely ill Americans.”

Wennberg’s recent work has focused on documenting outcomes and communicating outcomes information to patients. This focus is reflected in his article in the Nov/Dec 2007 issue of Health Affairs. In the first part of a two-part article, Wennberg and coauthors urge the Centers for Medicare and Medicaid Services (CMS) to use its pay-for-performance program to ensure that patients are both informed and empowered to choose appropriate discretionary treatments.

[edit] Work in Unwarranted Variation

In 1967, Dr. Wennberg worked with the Regional Medical Program created with a $350,000 grant from President Lyndon B. Johnson and began analyzing Medicare data to determine how well hospitals and doctors were performing."Our results were fascinating, because they ran completely counter to what conventional wisdom said they would be. Everyone expected that we would clearly see underservice in the rural hospital service areas remote from academic medical centers. But when we looked at the data, we found tremendous variation in every aspect of healthcare delivery, even among communities served by academic medical centers. We found the same thing when we compare healthcare in the Boston and New Haven communities served by some of the finest academic medical centers in the world. The basic premise - that medicine was driven by science and by physicians capable of making clinical decisions based on well-established fact and theory - was simply incompatible with the data we saw. It was immediately apparent that suppliers were more important in driving demand than had been previously realized," stated Dr. Wennberg. ^[3]

"The solution for unwarranted variation in preference-sensitive services is shared decision-making - the active involvement of the patient in choosing. Numerous clinical trials have shown that the patient decision-support programs, such as those available from Health Dialog and the Foundation for Informed Medical Decision-Making, result in better decision and often a reduction in utilization. But implementation isn't easy," he says. "We need to find a way to encourage and compensate physicians for the time they spend on educating and discussing things with patients."

[edit] Health Dialog

Dr. Albert Mulley, a physician at Massachusetts General Hospital, had been conducting research with John Wennberg of Dartmouth through the Foundation for Informed Decision-Making. Together, they'd built "substantial evidence that there's a huge variation in how doctors interpret their science through their own values and preferences." George Bennett, a serial entrepreneur "couldn't resist getting involved" in helping the process of enabling patients become a part of the decision-making process. As stated by Mr. Bennett, "It was one of life's strange twists, where they had something that was morally right, medically right, politically right and it saved money." By teaming with Kevin Kimberlin of Spencer Trask & Co., Health Dialog received it's initial funding.^[4]

[edit] Lowering Medicare Costs

"Americans have assumed that the fact that we spend so much more on health care than any other country stands as proof that we have the best health-care system in the world. But over the past 20 years, work done by Dartmouth’s Dr. John Wennberg and Dr. Elliott Fisher has forced U.S. health care leaders to acknowledge that this simply isn’t true."^[5]

The potential savings under such an ideal arrangement are immense. If every Medicare provider in the country spent at the same rate as the lowest 10% of providers in the program, overall costs would be slashed by 30%. That alone is enough to pay for the elusive Medicare drug benefit. Additional savings might well accrue if we could implement shared decision-making, reduce underuse of preventive services, and reduce medical errors.^[6]

[edit] Awards

• Most Influential Policy Maker of the Past 25 Years, Health Affairs, Nov. 1, 1997.
• Distinguished Investigator Award, Association for Health Services Research
• Foundation’s Health Services Research Prize, Baxter Foundation
• The Richard and Hinda Rosenthal Foundation Award in Clinical Medicine
• 2007 Ernest Amory Codman Award, The Joint Commission

[edit] Publications

• Wennberg, JE, Fisher ES, editors. The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program by the Dartmouth Atlas Project. The Center for the Evaluative Clinical Sciences, Dartmouth Atlas Project, Hanover, New Hampshire 2006 (online).
• Wennberg JE, Fisher ES, Baker L, Sharp SM, Bronner KK. The Care of Patients with Severe Chronic Illness: Evaluating the efficiency of California providers in caring for patients with chronic illness. Published November 16, 2005 as Web-Exclusive on Health Affairs website: http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.526/DC1.
• Wennberg, JE, Fisher ES, Stukel TA, Sharp SM. Use of Medicare claims data to monitor provider-specific performance among patients with severe chronic illness. Published October 7, 2004 as Web-Exclusive on Health Affairs website: http://content.healthaffairs.org/cgi/content/full/hlthaff.var.5/DC1.
• Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ 2004 328: p. 607-611.
• Barry MJ, Fowler FJ, Mulley AG, Henderson JV, Wennberg JE. Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care 1995; 33:771-782.

[edit] References

[edit] External links

• Spencer Trask & Company