Samuel Nussbaum, M.D., a pioneering researcher in endocrinology; a clinician medical group leader and instructor; and a veteran hospital and health plan executive, is the winner of the sixth annual Physician Executive Award of Excellence sponsored by the American College of Physician Executives and Modern Physician.
Nussbaum, 55, is executive vice president and chief medical officer of Anthem, the Indianapolis-based holder of Blue Cross and Blue Shield franchises in seven states that is merging with WellPoint Health Networks to create the largest healthcare insurer in the U.S. with nearly 26 million members in 13 states.
"I see the world through three lenses," Nussbaum says, describing the three stages of his career as a clinician researcher, provider organization leader and health plan executive. "I love what I do. I've loved and been impassioned about each phase of my career."
Nussbaum earned his medical degree in 1973 from Mount Sinai School of Medicine in New York. He completed an internship and began his residency in internal medicine at Stanford University. He completed his residency at Massachusetts General Hospital in 1976 and returned to Stanford to work as a clinical instructor. In 1977, Nussbaum went back to Boston, where he completed a clinical and research fellowship in endocrinology at Massachusetts General and then a research fellowship in medicine at Harvard Medical School. He is board-certified in internal medicine and specialty-certified in endocrinology and metabolism.
He joined the faculty of Harvard Medical School in 1980 and rose to lead Endocrine Associates, a group of more than a dozen specialists at Massachusetts General Hospital. His clinical research led to new therapies for osteoporosis and skeletal complications of malignancy, as well as new technologies to measure hormones in the blood.
His work as a physician group leader led to his appointment to the board of directors of Bay State Health Care, a troubled 400,000-member HMO in Massachusetts, and the introduction to the third phase of his career as a health plan executive.
"It had all the dynamics," Nussbaum says of his tenure at Bay State. "You had all the public policy to deal with, with a failing HMO. You had to deal with the governor's office and the insurance commissioner. How are you to handle the fiduciary duty? It was really the transformation of the health plan to deliver high-quality care."
In 1992, the board took over operations of Bay State and, in a restructuring, Nussbaum was named chairman. He steered it through a merger with the Massachusetts Blues; became a member of that board; and later was named its senior vice president of healthcare delivery.
At the Massachusetts Blues, Nussbaum says he had a chance to work with Partners HealthCare System, a hospital system formed in 1994 with the merger of Massachusetts General and Brigham and Women's hospitals, "to create a truly integrated delivery model," a rainbow he would later chase to St. Louis in 1996 at BJC Health System. When it became clear the Partners integrated model "wasn't going to achieve all it was going to achieve, I had a tremendous opportunity to come to BJC, one of the preeminent integrated delivery systems in the U.S."
Nussbaum became BJC's first executive vice president for medical affairs and system integration. He also served as chairman and chief executive officer of Health Partners of the Midwest, an HMO joint venture between BJC and Washington University School of Medicine in St. Louis, part of an initiative to create a fully integrated healthcare system in the Midwest. But in early 2001, BJC sold the money-losing plan, at that time covering about 65,000 commercial members, for a reported $4.5 million.
Different point of view
Clay Dunagan, M.D., vice president of quality at BJC and director of the system's Center for Healthcare Quality and Effectiveness when Nussbaum arrived in 1996, says Nussbaum's experience on both the payer and provider sides "was critical in forming his attitudes and ideas." At BJC, Nussbaum looked for ways to fund quality improvements for payers and providers, Dunagan says. "It was a tremendous asset to have someone who knew more than one point of view," Dunagan says.
Dunagan says Nussbaum saw the opportunity through an integrated system to achieve the end goal of better patient care.
To this day, Nussbaum retains a soft spot for the fully integrated system. "If you look at the gaps in healthcare, the major failure is in integration," Nussbaum says. "I believe, in the ideal world, it's still the model to achieve."
At BJC, Nussbaum broadened the quality center's reach, pushed for larger budgets and initiated disease management programs in asthma and heart failure, Dunagan says. The heart failure plan, now part of a Medicare demonstration project, was the subject of a formal study that "definitely proved we could impact a patient population with" disease management, he says.
Nussbaum also pioneered a 40-hour "mini-MBA" business leadership training program for BJC physicians, using faculty members from nearby Washington University.
Nussbaum joined Anthem in January 2001 and is helping lead the payer's efforts to use its enormous database to drive quality improvement, from measuring the clinical effectiveness of drugs to surgical complication rates, from disease management practices to a coronary services program. With coronary cases, "We measure deeply and broadly clinical detail--beta-blockers, who goes back to the (operating room), how many grafts were used."
But Anthem thus far has no plan to join the recent effort by some of its giant insurance industry peers in using that data to prepare public report cards on physicians. Anthem data is shared with hospital CEOs, chiefs of cardiology and chief medical officers, Nussbaum says, and they in turn present the data to the physicians at their facilities.
"We've chosen not to do anything doc by doc," Nussbaum says.
The plan also is using its database to help physicians identify patients who are candidates for disease management programs and to recommend evidence-based treatments. "We're touching patients, but we're not doing it without the doctor being involved," he says. "I think it's good in health plans that we invest in predictive models. I think it needs to be in partnership with doctors."
Nussbaum says one thrill at Anthem is the broad potential impact he can have on health policy. "I've had the opportunity to appear before Congress to talk about disease management," Nussbaum says. "We're one of the nation's leaders in pay for performance. We've got to find ways of rewarding physicians who work hard to obtain better results and invest in technologies to obtain better results, and achieve them."
Dunagan, describing the most effective leadership traits of his former boss, says: "He is charming. He's an outstanding thinker. He's unfettered by traditional thinking" and "pretty fearless in terms of his approach. I never saw him back down."