LDI Health Policy Seminar Series
Summary: Voltage Drop to Quality: Transforming Insurance Into Quality Care
John M. Eisenberg, M.D., M.B.A., Director, AHRQ
March 14, 2000

John M. Eisenberg, M.D., M.B.A., Director of the Agency for Healthcare Research and Quality (formerly AHCPR) visited the Leonard Davis Institute to discuss a new way to conceptualize the link between health insurance and quality of care. Many people mistakenly equate universal health coverage with the delivery of quality health care. However, he argued, adequate health insurance is just one step in the path toward providing quality care to all Americans. Dr. Eisenberg presented a model analogous to the way in which electrical power travels from a central power station to the population. As electricity flows from the power station, it loses voltage due to resistance at certain points in its path. At these points, transformers are used to increase the voltage, so that consumers receive adequate power by the time it reaches their homes. While acknowledging that "health care is certainly not a super conductor," Dr. Eisenberg sketched out a similar model to describe the pathway from production of health care resources to the delivery of quality health care. By analogy, Dr. Eisenberg discussed the "voltage drops" that can occur due to lack of insurance or underinsurance, regional disparity in physician practice patterns, limited access to appropriate sources of care, limited scope of benefits in insurance plans, and lack of consumer choice of plans and providers and poor quality of clinical services. The "transformers" for these drops, according to Dr. Eisenberg, are evidence-based medicine, improved dissemination of research findings, and evidence-based policy making.

Dr. Eisenberg also responded to questions from the audience about universal coverage, assessing quality of care, and the AHRQ's research agenda. He also commented on the impact of the National Committee for Quality Assurance (NCQA) performance data, also known as HEDIS measures, that assesses quality in American health plans. Dr. Eisenberg cautioned that while HEDIS information has potential, it is of limited use now because, as of recently about two-thirds of health plans in the United States do not submit data to NCQA. In addition, rating health plans on quality is useful only if consumers have a choice of plans. However, recent surveys indicate that only about half of all Americans have a choice of more than one employer-sponsored plan. In addition, many purchasers still tend to select plans based on cost rather than quality, and know very little about NCQA's measures.

Commenting on the recent Institute of Medicine report on medical errors, Dr. Eisenberg stressed the need for more funding for research on this important issue. According to the IOM report, medical errors are the eighth leading cause of death in the United States. As such, said Dr. Eisenberg, amount earmarked by the federal government for research in this area will be a down payment on what is needed. To overcome the paucity of research in this area, the AHRQ has incorporated research on medical errors into its agenda. Other AHRQ agenda items include devoting more resources to research, disseminating research findings more broadly, and translating research into policy. AHRQ also intends to foster partnerships with professional societies to promote development of evidence-based medicine and to broaden the constituency for its research findings.

In conclusion, Dr. Eisenberg stressed that achieving quality health care for all will take more than implementing universal coverage or establishing a patient bill of rights. He urged a more comprehensive approach to identifying the voltage drops in the health care pathway, and pledged the AHRQ's support in transforming the delivery of American health care.

Related Links:
Research on Medical Errors, from the AHRQ, provides links to additional information on medical errors and patient safety.

Biosketch: John M. Eisenberg, M.D., M.B.A.
Director, Agency for Health Care Research and Quality

John M. Eisenberg, M.D., M.B.A. was appointed Administrator of the Agency for Health Care Policy and Research (AHCPR), the predecessor to AHRQ, in April 1997. As Director of AHRQ, Dr. Eisenberg oversees the lead Federal agency charged with conducting and sponsoring research to enhance the quality, appropriateness, and effectiveness of health care services; address medical errors; and broaden access to care.

Dr. Eisenberg also serves as the Senior Advisor to the Secretary on Quality, with AHCPR designated as the lead agency for health care quality improvement issues in the Department of Health and Human Service (HHS). He also co-chairs the Department's Data Council. He has served as Principal Deputy Assistant Secretary for Health and as Acting Assistant Secretary for Health.

A clinician and researcher, Dr. Eisenberg has held key positions in academic and clinical medicine. Prior to his appointment at AHCPR, Dr. Eisenberg was Chairman of the Department of Medicine and Physician-in-Chief at Georgetown University. Previously, he was Chief of the Division of General Internal Medicine at the University of Pennsylvania.

From 1986 through 1995, Dr. Eisenberg was a founding Commissioner of the Congressional Physician Payment Review Commission, serving as its Chairman from 1993-95. He was the first physician to be elected President of the Association for Health Services Research, has been President of the Society for General Internal Medicine, and Vice-President of the Society
for Medical Decision Making. Dr. Eisenberg is a member of the Institute of Medicine of the National Academy of Sciences. He has served on the Board of Regents of the American College of Physicians and is a Master of the College, and was on the American Board of Internal Medicine.

Dr. Eisenberg has published over 250 articles and book chapters on topics such as physicians' practices, test use and efficacy, medical education, and clinical economics as well as a book, Doctors' Decisions and the Cost of Medical Care. He was co-author of Paying Physicians, co-editor of The Physician's Practice, and an editor of Stein's textbook, Internal Medicine.

He is a magna cum laude graduate of Princeton University (1968) and the Washington University School of Medicine in St. Louis (1972). After his residency in Internal Medicine at the University of Pennsylvania, he was a Robert Wood Johnson Foundation Clinical Scholar and earned a Master of Business Administration degree at the Wharton School with distinction.

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