Placement: Harvard T. H. School of Public Health
Mentor: Ashish Jha, M.D., M.P.H. (Director, Harvard Global Health Institute and K.T. Li Professor of International Health and Health Policy, Harvard T.H. Chan School of Public Health)
Co-Mentor: Thomas Lee, M.D. (Chief Medical Officer, Press Ganey Associates, Inc.)
Project Title: Value-based Surgery in the Context of Accountable Care Organizations
Alice Murray, B.Sc., M.B.B.S, M.R.C.S., is a 2016-17 U.K. Harkness Fellow in Health Care Policy and Practice. She recently completed a clinical research fellowship in Academic Surgery under Professor Lord Ara Darzi at Imperial College, a Colorectal Research Fellow at Columbia University’s Center for Innovation and Outcomes Research, and is a General Surgery Registrar at London Deanery, North East Thames. Murray spent five years in the National Health Service as a surgical trainee, and ranked second out of 536 candidates across the U.K. for her senior post. She is now pursuing a Ph.D. at Imperial College, where she is evaluating the utility of international comparisons of the quality of surgical care. In addition to her Ph.D. work, she researched surgical outcomes in the U.S. and designed and developed an electronic outcomes database at New York Presbyterian that is being rolled out to all surgical departments. After a year as a research fellow at Columbia University, she helped create an established fellowship, which going forward will support U.K. surgical trainees to undertake one year at New York Presbyterian and two years at Imperial College as part of an ongoing U.S/U.K. collaboration. Murray was awarded an academic scholarship from Oxford University for her pre-clinical medical studies and received her final degree from Royal Free and University College London Medical School.
Accountable Care Organizations (ACOs) represent a promising new model for healthcare delivery, seeking to improve value through aligning providers’ financial incentives and encouraging the integration and coordination of services across siloes. The focus within ACOs to date has been on primary and preventative health care, but there is potential for significant savings and quality improvement within specialist services. This project seeks to evaluate the effect of alternative payment models on changes to the delivery of surgical services.
In phase one, a quantitative study will be performed using CMS Medicare data to evaluate the effect of ACO enrollment on the utilization, cost and quality of selected high-volume surgical procedures. The second phase of this project will identify the structures and strategies of ACOs that are associated with higher value surgical care. Finally, case-studies will be performed in order to carry out in-depth semi-structured interviews of ACO leaders and surgeons, focusing on changes associated with ACO-enrollment. The results of this work are intended to inform policy makers, health care leaders, and clinicians in both the U.S. and U.K. who are seeking ways to improve surgical value within new payment models.