Pioneers Wanted: Academic Medicine is Advancing Medicine

By Peter L. Slavin, MD

Massachusetts is among a very small number of states that have expanded access to health insurance to almost all its citizens. Since the passage of Massachusetts health reform in 2006, the rate of uninsured in the state has fallen from 10 percent to 2 percent. Other states also have taken access to health care to heart. Since 1974, for example, Hawaii has required all employers to provide specific health care benefits to any employee who works at least 20 hours a week. In 2009, Connecticut passed a plan called “Sustinet” that should help achieve health insurance coverage for 98 percent of its residents by 2014.

Massachusetts is pushing the envelope further, trying to lead, not only in expanding access, but also in controlling the rise of health care costs. In fact, five of the nation’s first 32 accountable care organizations (Pioneer ACOs) are located in the Greater Boston area. All of the health systems selected as ACOs will be experimenting with a variety of innovations in patient care, aimed at making care better and more affordable for Medicare beneficiaries.

The Pioneer models will bring expected savings of $1 billion over the next five years nationally, affecting 150,000 seniors in the Boston area alone. The Pioneer ACOs will help demonstrate novel ways to bend the cost curve and allow participating providers to gain valuable experience in population health management.

Pioneer ACOs will likely adopt a variety of strategies to manage their populations. Some may focus on providing improved care coordination to patients with such disorders as chronic lung disease, diabetes, and congestive heart failure. Others will try to link primary care and specialty care providers more effectively. Still others will concentrate on the prevention of admissions and readmissions.

Partners HealthCare, a system founded by Massachusetts General Hospital and Brigham and Women’s Hospital, was fortunate to be one of the 32 organizations selected as a Pioneer ACO. Partners plans to focus initially on the management of high-risk, high-cost Medicare beneficiaries. We have already been at this on a more limited scale for six years as a participant in a Medicare demonstration project. We have found that by embedding care management resources in our primary care physician offices, we can significantly reduce the cost of care for our high-cost Medicare primary care patients while improving their care. For every dollar invested in the program, we have been able to save $2.65 in Medicare expense. The Pioneer ACO and similar commercial insurance initiatives will allow us to expand our care management efforts to much broader populations.

Why would a health care organization take on such risk? Frankly, I don’t think we have a choice. Health care costs simply cannot continue to rise indefinitely, at a rate 2 percent faster than the rest of the economy. The budgets of our federal government, state governments, businesses, families, and individuals can no longer afford such increases. If we do nothing to redesign the care we deliver, we can look forward to years of unending rate cuts from public and private insurers. Eventually these rate cuts will adversely affect our ability to deliver high-quality care and will destabilize the finances of our institutions. Alternatively, we can try to manage the utilization of health care services proactively, and through an ACO-like model, slow the rate of increase in health care costs for our society and realize some of the financial benefit for doing so.

As medical schools and teaching hospitals, we have a responsibility to be leaders in this effort. Just as we have led and made considerable progress through our biomedical research in developing better ways to diagnose and treat such disorders as heart disease and cancer, we must now also lead in overhauling the way care is delivered to the American people. Our workforce has the talent, dedication, and passion to develop, implement, and rigorously prove the countless innovations in care redesign that will be required for this task.

Our institutions have built their reputations by tackling society’s most pressing health care problems. Our future reputations will rise or fall depending on our ability to continue advancing medicine. Bending the cost curve thoughtfully is certainly among our nation’s most pressing health care problems. We must unleash the creativity of each of our organizations in an aggressive effort to improve care and to make care less costly. We also need to find ways to learn from one another about our respective failures and successes.

Hence, this blog. We hope this site will serve as a convenient and helpful place for leaders in academic medicine to share their successes and failures in their efforts to redesign care and manage populations. We hope you will contribute to it and learn from it. We hope it becomes a place for academic medicine to gather, share effective practices, celebrate innovations, and — most important — catalyze the change that our society so desperately needs.

We hope you will join us.

Peter L. Slavin, MD, is the president of Massachusetts General Hospital. He is a professor of health care policy at Harvard Medical School where he teaches internal medicine and health care management. He can be reached at

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