From Pariah To Pioneer

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Read the full story by Shannon Brownlee, published in the Fall 2013 issue of Dartmouth Medicine.

Billboards still advertise the latest in medical technology, and emergency rooms still bustle with harried nurses and doctors. But below the surface of the nation’s health-care system, tectonic shifts in how care is organized and paid for are causing a level of turmoil and anxiety that has not been seen in health care since the rise and fall of managed care in the 1990s.

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Over the past 40 years, Dartmouth’s John Wennberg has helped to change the way physicians and patients approach medical decision making. (Photo by Lars Blackmore)

Both clinicians and administrators are worried as a result of the implementation of the Affordable Care Act of 2010. Doctors are justifiably concerned about everything from their incomes to a changing job market. Hospital administrators are being forced to improve the safety of their institutions, trim waste and cut costs, and ensure that patients are not subjected to unwanted surgeries and tests and unneeded days in a hospital bed.

One of the instigators of all these changes is Dartmouth’s John Wennberg, the founder and director emeritus of the Dartmouth Institute for Health Policy & Clinical Practice (TDI) at the Geisel School of Medicine, the founder of the Dartmouth Atlas Project and the Peggy Y. Thomson Professor Emeritus in the Evaluative Clinical Sciences at Geisel. Over the past four decades, Wennberg and his colleagues at Dartmouth and other institutions have conducted pioneering research that has reshaped the way policymakers and legislators view the health-care landscape. Dartmouth researchers have shown that far from having the “best health care in the world,” as some politicians have claimed, and as many Americans may still believe, the nation is plagued by wide variability in both cost and quality. What’s more, a great deal of care delivered in the U.S. is not only unnecessary but also potentially harmful to patients.

The changing understanding of health care caused by this research has led directly to health-care reform legislation at both the federal and state level. The Accountable Care Act is one example. As another, a Vermont law passed in 2011 put the state on a path toward a single-payer system that would incorporate ideas for improving care that have their roots in Dartmouth research.

Ron Suskind, a Pulitzer Prize-winning journalist, calls Wennberg “a modern-day Copernicus” for his paradigm-changing insights into the nature of the health care system. And just as Copernicus faced resistance, Wennberg and his colleagues have found that the implications of their findings are not always welcomed by providers of health care. Still, over the 40 years since his earliest studies were published, Wennberg’s research has affected a remarkably wide array of policy issues, from health care financing to the relationship between doctors and patients, and his work will continue to have an impact on health care reform for years to come.