International Workshop:

Pay for Performance

Can it Improve the Quality and Value of Israeli Health Care ?

Chairmen:

Ronni Gamzu

Charles N. Kahn

September 2-3, 2009

Caesarea, Israel

Paying for Performance. Now.

In his pioneering paper entitled "Uncertainty and the Welfare Economics of Medical Care" Nobel-prize winner Kenneth J. Arrow highlighted the significant role of 'product uncertainty' as one of the special characteristics of the medical care market. Almost 45 years later, the planned health reform in the U.S. includes the advancement of health information to increase the value for money. Paying for performance (P4P) strategies are supposed to increase the quality and value for money.

Healthcare policy-makers worldwide pursue structure and process reforms to adjust the growing challenges of the health market. Yet, we all fail to assure ourselves that such innovations improve the quality of care. The state of the reimbursement system between hospitals and HMOs in the Israel healthcare system can be seen as a perfect example. Until recently, the reimbursement system paid hospitals chiefly on the basis on bed days used. The system gradually reformed to include more DRGs in an attempt to increase efficiency. Yet, clinical outcomes and performance remain absent in this equation.

It is often claimed that the cost of hospital treatment has more to do with number of physicians, number of medical specialties and the procedures they prefer - than the real health improvement. Any quantity and procedure-based payments are subject to “creative” management (e.g. DRG creep) to maximize tariff revenue. Payers are used to: forgo) the quality issue due to information barriers and overall uncertainty. The Israel healthcare system is not an exception when it comes to notions such as these.

The Israel healthcare system is facing many challenges. Most of them originate from the fragmented structure of the system that yields contradictory interests - almost unbridgeable. Maximizing the quality of care should be a consensual interest. To achieve this aim; all parties should embrace reimbursement systems based on quality and performance in a 'risk sharing' manner. The time for P4P is now.

Ronni Gamzu

THE ISRAEL NATIONAL INSTITUTE FOR HEALTH POLICY RESEARCH

Table of Contents

Page

1. Workshop Program 4

2. List of Speakers and Chairmen 7

3. Abstracts 9

4. Biographies 21

International Workshop : Pay for Performance Can it Improve the Quality and Value of Israeli Health Care ?

September 2-3, 2009, Caesarea, Israel

September 2, 2009

8:30 – 9:30 Registration + Light Breakfast 9:30 – 11:00 Opening Session - Chairman: Shlomo Mor-Yosef

Yaakov Litzman, Deputy Minister of Health

Background and Aims of the Conference: Ronni Gamzu & Charles N. Kahn

The Influence of Incentives on Worker Performance Miriam Erez

Quality Measurement and Improvement; in Theory and in Practice Charles N. Kahn

P4P as a part of International initiatives to Improve the Quality and Value of Healthcare: Now and Tomorrow

11:00 – 11:30 Coffee Break

11:30 – 13:00 Session 2 - Chairman: Yair Birnbaum

A Higher Quality and More Efficient Healthcare System in a Diffused and Fractionated Health System; Is this Possible ? Janet Corrigan

The purpose of this session is to provide an outline of the discussion on the need to improve the healthcare system in order to provide higher quality of care and greater efficiency. How can one achieve a higher quality and more efficient healthcare system in such a fractionated and diffused system of insurers, providers, and policy makers? What is the importance of “systemness;” can it be accomplished, and can we assume it improves quality when most of the care insured or provided for in the country is so diffuse ?

Health System Transformation: Policy, Practice, and Performance Measures in the Private (HCA) and Public (VA) Sectors Jonathan Perlin

Improving value in health care is a challenge faced by many countries, especially the United States. The U.S. Veterans Health Administration (VHA) operates independently of mainstream U.S. healthcare. It faced intense scrutiny regarding quality, access, and value and underwent a transition of its operating model from being a “safety net sick care” provider to offering health promotion and disease management. Using broad performance measurement and electronic health records, the VHA system underwent a transformation so sweeping that RAND investigators found it generally outperformed other settings. Toward informing the discussion on performance measures and health information technologies in its improvement of value; this session examines the parallel challenges and opportunities in the VHA experience and other healthcare settings.

Open Discussion

13:00 – 14:00 Lunch

14:00 – 15:30 Session 3 - Chairman: Alexander Aviram

Measuring the Right Thing - The Key to the Successful Engagement of Physicians and Patients Paul C. Tang

Changing health outcomes requires physician and patient engagement. Credible quality measures are shown to lead to sustainable change – both with physicians and with patients. Physician-facing electronic health records and patient-facing personal health records provide essential tools for enabling and maintaining change. How should measures be designed and how should they be applied to motivate, create, and sustain continuous quality improvement by the healthcare team? How is data used to motivate patients to take a more active role in their self-management? Creating a data-driven partnership between physicians and patients drives quality to a new level.

Are the Right Things Being Measured ? Elisheva Simchen

Choosing the variables for measurement must assume a strong correlation between that which is being measured and the quality of care. Process measurements mandate a clear understanding between the actions to be carried out and the outcomes. Outcome measurements, on the other hand, neglect the developments leading to one particular measure. What is the balance between the two? And what is the impact of measurement selection? Are the right things being measured at the right level? Is it possible to move from process level measures to patient episodes of care measures - and could this lead to more integrated care ?

Open Discussion

15:30 – 16:00 Coffee Break

16:00 – 18:00 Session 4 - Chairman: Avi Porath

P4P - Like Models - The Israeli Experience Asher Elhayany

The Effect of Pay for Performance (P4P) on Quality of Care in the Cardiac Surgery Department. A Pioneer Experiment; Preliminary Results. Ahuva Weiss-Meilik

Data will be presented on an experiment performed in a cardiothoracic department in Israel that incorporated a P4P model aimed at improving clinical outcomes. The objectives are to examine the effect of employing the P4P method on process measures and clinical outcomes in CABG and valve surgery . In this session the research outline will be presented and the preliminary results will be demonstrated .

Panel Discussion: Ronni Gamzu, Charles N. Kahn, Ehud Raanani, Gideon Uretzky

19:30 – 22:00 Dinner

September 3, 2009

09:00 – 11:00 Session 5 - Chairman: Joshua Shemer

P4P - Are There Unintended Consequences? Robert Berenson

There is very little empirical data that demonstrates one way or the other whether P4P actually does improve quality – and at what cost. Indeed, a recent analysis of the Medicare P4P demonstration concluded that hospitals appear largely unmotivated by the P4P program; although participating hospitals do increase efforts for some easy tasks. What are the major issues that need to be considered in proceeding with P4P regimes? A fundamental question is whether or not providers respond to P4P incentives by positively changing organizational culture or, alternatively, respond by “testing to the test” of what is being measured? These and other issues will be addressed, along with some suggestions for minimizing unintended negative consequences.

Chairman: Joshua Shemer HMO's Panel : Zeev Aharonson, Nicky Lieberman, Ehud Kokia, Daniel Vardy

Chairman: Yair Shapiro Hospital's Panel : Rafael Beyar, Yair Birnbaum, Orna Blondheim

11:00 – 11:30 Coffee Break

11:30 – 13:00 Session 6 – Chairman: Gabi Barbash

HIT- The Challenges Julian Zelingher

HIT has been labeled as an enabler of quality enhancement, value, and performance. However, at this point, the evidence about which HIT innovations are the most effective in achieving higher quality and greater efficiency is unclear. What does research suggest regarding HIT’s impact on quality and efficiency? Can we have an efficient and high-performing healthcare delivery system without HIT? The importance of HIT: in this session, the representatives of HIT - which is already in use - will present its advantages in measuring quality. And finally, do we need a unified HIT system for measuring and reporting quality ?

Panel Discussion: Gabi Barbash, Eyran Halpern, Joseph Rosenblum, Paul C. Tang

13:00 – 14:00 Lunch

14:00 – 16:30 Closing Session - Chairman: Gabi Bin Nun

What Should Be Our Plan of Action? Adjusting the Payment System in Israel. A Working Proposal for P4P over a Two Year Period Ronni Gamzu, Charles N. Kahn

The purpose of this session is to offer an economic perspective and to adjust the payment system in Israel to create a working draft of a P4P model for the Israeli system . The P4P model will focus on: “the linkage between payers and providers” (HMO’s – Hospitals), and “the linkage between physicians and employers.” At the end of this session, four opinion leaders will discuss a model draft.

Panel Discussion: Robert Berenson, Janet Corrigan, Tuvia Horev, Jonathan Perlin, Paul C. Tang, Avi Israeli

Recapping the discussion of the past two days, the practical solutions and policy options are to be explored. Where should the healthcare system be headed and how can we achieve these goals ?

Coffee to go List of Speakers and Chairmen

Dr. Zeev Aharonson, Medical Director, Meuhedet Health Services Prof. Alexander Aviram , Scientific Director, NIHP Prof. Gabriel Barbash, Director General, Tel Aviv Sourasky Medical Center Dr. Robert Berenson, University of North Carolina School of Public Health and the Fuqua School of Business at Duke University Prof. Rafael Beyar, Director, Rambam Health Care Campus Prof. Gabi Bin Nun, Heath Systems Management, Ben-Gurion University of the Negev Dr. Yair Birnbaum, Head of Medical Services at the Hadassah Medical Organization Dr. Orna Blondheim, Director, Haemek Medical Center Dr. Janet Corrigan, President and CEO, National Quality Forum Dr. Benny Davidson, Director General, Assaf Harofe Medical Center Dr. Asher Elhayany, Director of Meir Medical Center Prof. Miriam Erez, Coordinator of The Status of Women at the Technion Dr. Ronni Gamzu, Director of the General Hospital, Tel Aviv Sourasky Medical Center Prof. Yonatan Halevy, Director General of Shaarei Tzedek Hospital Dr. Eyran Halpern, Chief Executive Officer, Rabin Medical Center Dr. Tuvia Horev, Deputy Director General of Finance, Ministry of Health Prof. Avi Israeli, Director General, Ministry of Health Mr. Charles N. Kahn, President, Federation of American Hospitals Dr. Ehud Kokia, Director General, Maccabi Healthcare Services Dr. Nicky Lieberman, Chairman, Medical Department, Clalit Health Services Rabbi Yaakov Litzman, Deputy Minister of Health Prof. Shlomo Mor-Yosef, Director General, Hadassah Hospital Dr. Jonathan Perlin, Chief Medical Officer and President, Clinical Services HMO Prof. Avi Porath, Medical Director, Maccabi Healthcare Services Dr. Ehud Raanani, Director of Cardiac Surgery, Sheba Medical Center Dr. Yossi Rosenblum, Director of Medical Information, Meuhedet Health Services Prof. Yair Shapiro, C.E.O., Assuta Medical Center Prof. Joshua Shemer, Chairman, Assuta Medical Center Prof. Elisheva Simchen, Department of Health Services Research, Ministry of Health Dr. Paul C. Tang, Vice President, Chief Medical Information Officer at the Palo Alto Medical Foundation Prof. Gideon Uretzky, Chairman, Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center Prof. Daniel Vardy, Medical Director, Leumit Health Fund Dr. Ahuva Weiss-Meilik, Research Department, Tel Aviv Sourasky Medical Center Dr. Julian Zelingher, Director of Medical Planning and Development at the Hospital Division, Clalit Health Services Headquarters, Tel Aviv

Abstracts Dr. Robert Berenson, University of North Carolina School of Public Health and the Fuqua School of Business at Duke University

P4P – Are There Unintended Consequences?

For an approach that has such a plausible logic, there is very little empirical data that demonstrates one way or the other whether P4P actually does improve quality – and at what cost. There is very little empirical data about the impact of P4P in health care and apparently the results of this approach in other sectors such as education is mixed – and controversial. A recent analysis of the Medicare P4P Premier demonstration concluded that hospitals appear largely unmotivated by the P4P program, although participating hospitals increase efforts for some easy tasks. Whether hospitals that were part of the Premier hospitals have improved performance in comparison to a secular trend showing broad improvement on the specific measures being monitored is a matter of ongoing research. Among issues that need to be considered in proceeding with P4P approaches include: the opportunity costs of emphasizing efforts to gain marginal payments instead of working to reform the incentives in the basic provider payment systems; the cost of data collection; whether improving performance on particular process measures actually does improve outcomes; whether particular approaches to P4P may reinforce provider “tiering” - in which the rich (those better able to invest in P4P programs) get richer and the poor get poorer, the tradeoffs between paying for performance vs. paying for improvement, and the breath of measures that might be used in P4P programs - some emphasizing activities that are not narrowly clinical in scope. A fundamental question is whether providers respond to P4P incentives by positively changing organizational culture, thereby also improving care in quality domains not being measured or, alternatively, respond by “testing to the test” of what is being measured, actually reducing their commitment to productive quality improvement programs that are not part of the P4P incentive programs. There is evidence to support both points of view. These and other issues will be addressed, along with some suggestions for minimizing unintended, negative consequences.

Dr. Janet Corrigan, President and CEO, National Quality Forum

Achieving Breakthroughs in Health Care Value Requires New Organizational Models

Fundamental reform of the healthcare delivery system is long overdue. The healthcare delivery system in the U.S., and in many other countries, is highly fragmented. This results in care that is poorly coordinated, often unsafe, and highly wasteful. New organizational models are needed to take full advantage of economies of scale in health information technology and specialized expertise. They are also needed to provide the necessary clinical integration to coordinate care across settings, clinicians, and time. There is no single “right” approach that will work in all communities, but an array of organizational options, including “medical homes,” multi-specialty groups, and various forms of integrated delivery systems. Some organizational arrangements are loosely structured and provide a good deal of autonomy and flexibility to participants while others are more hardwired and standardized. There is a slim but growing body of evidence to support the benefits of multi-specialty groups and integrated delivery systems, but far more research is needed to understand the effects of various organizational models on quality and cost. New payment policies are needed to encourage and reward the development of organizational models best able to produce “value” - better patient outcomes and more affordable care. Aligning payment with value is also a critical first step to securing the necessary capital investments to build high performing organizations. There is much interest in identifying organizational models that can serve as “accountable care organizations;” entities capable of accepting responsibility for providing comprehensive care to patients with chronic conditions in return for a bundled payment. A comprehensive policy agenda for promoting new organizational models includes: national priorities and goals that require higher levels of organizational capacity, demonstrations projects, payment reform, health information technology standards and capital investment, community-wide collaborative infrastructures, professional education, and a public information campaign.

Dr. Asher Elhayany, CEO of Meir Medical Center, Clalit Health Services

Pay-for-Performance Programs in Israeli Sick Funds

Asher Elhaynay, Revital Gross, Nurit Friedman

Purpose – This presentation aims to analyze the development of “pay-for-performance” (P4P) programs implemented by Israel’s two largest sick funds insuring 78 percent of the population. Design/Methodology/Approach – Analysis of the main features, their evolution over time, and the observed outcomes and concerns related to implementing these programs. Findings – Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance by focusing attention on measured areas while neglecting other areas. This motivates a statistical approach to patient care instead of providing patient- centered care. Originality/Value – The Israeli case provides an interesting example of nation-wide, long-term implementation of the pay-for-performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlights issues related to the outcomes of P4P programs.

Prof. Miriam Erez, Coordinator of The Status of Women at the Technion

Pay-For Performance – How Effective Is It and under What Conditions?

The effectiveness of "pay for performance" depends on a number of factors: A. The measures used as indicators of performance B. The fit between the performance measures and the goals of the healthcare organization C. The structure of the pay system and other rewards D. The fit between the pay system and the work design (for example, individual versus team-based) E. The distributive justice and the procedural justice in the reward allocation system. Each one of these factors and their implications to the effectiveness of "pay-for- performance" will be discussed

Dr. Ronni Gamzu, Director of the General Hospital, Tel Aviv Sourasky Medical Center What Should Be Our Plan of Action? Adjusting the Payment System in Israel. A Working Proposal for P4P over a Two Year Period

The popularity of paying for performance (P4P) in the American health system has been steadily increasing in the last seven years. Approximately 200 P4Ps programs are active in most of the states. England, Europe, and Australia have implemented such programs as well. The debate on their effect is not yet settled yet most of the studies prove its benefits. It is obvious that P4P incentives can be very powerful in their effects. Thus, caution in their design and adjustment is essential. On the other hand, ignoring their potential would be insensible, as they offer the possibility of improving a higher value for reimbursement for taxpayers, insurers, and patients. P4P reforms have to be carefully designed, implemented, and evaluated. Piloting is essential in order to determine local feasibility and to ‘fine-tune’ instrumentation and measurement. Campbell et al. (2009) have presented in the NEJM that P4P scheme accelerated improvements in quality in the short term only. The improvement in the quality of care slowed once targets were reached. Therefore, to maximize success, future P4P programs should incorporate the lessons and insights obtained from previous experience. Scott (2008) reviewed published trials, program evaluations, and position statements and concluded the following principles that may guide future program design and implementation: 1) formulate a rationale and a business case for P4P; 2) use established evidence-based performance measures; 3) use rigorous and verifiable methods of data collection and analysis; 4) define performance targets using absolute and relative thresholds; 5) use rewards that are sufficient, equitable and transparent; 6) address appropriateness of provider responses and avoid perverse incentives; 7) implement communication and feedback strategies; 8) use existing organizational structures to implement P4P programs; 9) attribute credit for performance to participants in ways that foster population-based perspectives; and 10) invest in outcomes and health service research. Recommendations flowing from these principles relevant to Israeli settings will be provided. Our challenge is to provide a recipe that will yield the best equilibrium among the primary three objectives: cost control, quality improvement, and risk protection for providers.

Mr. Charles N. Kahn, President, Federation of American Hospitals

Quality Measurement and Improvement; in Theory and in Practice

Concern over the quality and safety of medical care in the United States has increased over the last decade particularly with reports from RAND Corporation that identified significant overuse and underuse of essential patient care and the National Academy of Sciences Institute of Medicine finding that as many as 98,000 deaths annually could be attributed to medical errors. In addition to these findings, the work of Dartmouth University researchers have consistently identified vast and unjustifiable disparities in the level of spending and services provided to seniors on Medicare from one area of the country to another with no apparent difference in outcomes or health status. These findings have prompted a movement in the United States that is both private and public sector inspired to measure and report on medical care performance. The next phase of this movement is to tie a portion of Medicare hospital payment to available metrics on clinical performance and outcomes as well as patient experiences. The presentation will focus on the issues that give rise to initiatives to link payment to medical care performance in the United States, the perspectives of the healthcare system stakeholders on measuring performance and the use of it to improve the quality and value of care, the policy and practice considerations that have become evident as the United States has begun to consider pay for medical care performance, a review of the major efforts to date on reporting of quality measures and pay for performance in the United States with a focus on hospitals, and a few examples of measuring performance and payment in Europe. The presentation will provide observations on where efforts in the United States will likely head next and observations on critical policy considerations for countries developing pay for performance including Israel.

Dr. Jonathan Perlin, Chief Medical Officer and President, Clinical Services HMO

Health System Transformation: Policy, Practice, and Performance Measures in the Private (HCA) and Public (VA) Sector

The United States debate over health reform has many dimensions. One of the most significant concerns is value, which may be represented as the relationship between outcomes and cost. Outcomes can be further characterized in terms of performance in quality, safety, access to care, patient function and patient experience. Research shows that despite the highest per capita health expenditures among industrialized countries, the United States lags significantly in measured performance. RAND researchers demonstrated that evidence-based services for the prevention and management of disease occur only 55 percent of the time, yet other data shows the overuse of procedurally-oriented services. Inadequate safety results in nearly 100,000 patients succumbing to generally avoidable adverse events, while another 99,000 die because of healthcare-acquired infections. In terms of access, one in six Americans are uninsured at any moment, and according to the Commonwealth Fund, over one-quarter of Americans lose coverage at some point each year - leading to difficulty in assuring preventive services and disease management. Moreover, the Dartmouth Health Atlas and other data shows a significant variation among states in value-for-dollar, with little correlation between per capita expenditures and performance on quality measures. Addressing value is highly contentious, but not novel. The U.S. Veterans Health Administration (VHA) faced similar challenges a decade ago. Implementing a plan for enhanced access, a transition from “safety net sick care” to health promotion and disease management, broad performance measurement, and full use of electronic health records and related technologies; the system underwent a transformation so sweeping that RAND investigators found it generally outperformed all other settings. Toward informing the discussion on the use of performance measures and health information technologies in improving value; this session examines the parallel challenges and opportunities in the VHA experience, the current U.S. reform debate, and potential implications for Israel.

Dr. Paul C. Tang, Vice President, Chief Medical Information Officer at the Palo Alto Medical Foundation

Measuring the Right Thing: Key to the Successful Engagement of Physicians and Patients

Healthcare costs continue to escalate across the globe. Many countries are exploring different ways of reimbursing physicians for the quality of care they provide rather than just paying for transactions and procedures. In the United States, incentives in the form of “Pay for Performance” (P4P) payments have been used in various public and private payer plans. Overall, however, quality has not significantly changed - as measured using current administrative metrics. Why hasn't P4P improved quality in the United States? Are we measuring the right things? Are the incentives adequate? Do physicians care? Do we provide system support for physicians to do the right thing? Do we incent the wrong things? Changing health outcomes requires more than implementation of traditional P4P programs – it requires physician and patient engagement. And it requires development of credible quality measures that drive sustainable change – by both physicians and patients. Physician-facing electronic health records and patient- facing personal health records provide essential tools for enabling and maintaining change. How should measures be designed and how should they be applied to motivate, create, and sustain continuous quality improvement by the health care team? How are data used to motivate patients to take a more active role in their self- management? Creating a data-driven partnership between physicians and patients drives quality to a new level. This talk will describe emerging quality measures based on clinical data from electronic health record systems used to drive clinical improvement by the healthcare team. In addition, patients' access to their own health data and online resources to effect change will help them actively participate in their care. It is the newly formed partnership of patients and their professional healthcare team that will produce significant improvements in the health outcomes of individuals and the population.

Dr. Ahuva Weiss-Meilik, Research Department, Tel Aviv Sourasky Medical Center

The Effect of Pay for Performance (P4P) on Quality of Care in the Cardiac Surgery Department. A Pioneer Experiment; Preliminary Results.

The Cardiothoracic Surgery department and Hospital Management at The Tel Aviv Medical Center set a target aimed at improving clinical outcomes. The present payment method is based on the fee-for-service principle where payment is determined by procedure type and scope of activity - unrelated to its quality and outcome. In the U.S., it is considered to be a cause of unreliability, complexity, and waste. The pay-for-performance (P4P) approach (currently not used in Israel) can act as an incentive for better performance and clinical outcomes - causing a direct link between quality measures and payment. This reimbursement method, customary in industry, has never been fully implemented in the health arena due to the lack of an appropriate technology. Following the introduction of the Electronic Medical Record (EMR), the implementation of P4P became feasible. Recent studies in the U.S. demonstrate controversial evidences on the influence of the P4P approach on quality of care. This method was selected as a tool for improving clinical performance in the Cardiothoracic Surgery department. Recently, a pioneer study was conducted examining the effect of the P4P model on clinical outcomes and process measures improvements in CABG and valve surgeries using case mix adjustment mechanism. The presentation will focus on: • The research design and methodology - emphasizing the indicators and measurement process. • The implementation of the P4P model, as a research intervention component and an interaction between the HMO’s and The Tel-Aviv Medical Center (Cardiothoracic Surgery department and Hospital Management). • Preliminary results. Dr. Julian Zelingher, Director of Medical Planning and Development at the Hospital Division, Clalit Health Services Headquarters, Tel Aviv

HIT- The Challenges

Similar to other quality improvement programs, the implementation of performance enhancement through financial incentives (P4P) interventions relies heavily on the widespread utilization of Health IT. Clinical and administrative information systems are utilized in P4P programs, both for the collection of process indicators (such as the timely documentation of key diagnoses and interventions) as well as for outcome detection (such as the analysis of target blood pressure or Hemoglobin A1C values). The aim of this presentation is to present a broad overview of current HIT applications in P4P programs, both in Israel and internationally. We will discus the potential role of the Electronic Health Records in P4P programs and compare the current status of EHR implementation in North America and Europe with that of Israel. The central role of community clinic-based EHR systems in the Israeli National Quality Indicators Program will be described. A comparison will be made of the advantages and hurdles of utilization of native clinical data sources (such as EHRs and LIS) vs. the utilization of dedicated tools for P4P data collection. The development and maintenance of Clinical Data Repositories, Executive Information Systems, and Organizational Data Warehouses are central to the process of collection, analysis, and the presentation of clinical performance data - both for administrative data (such as bonus payment) as well as for research and decision making. Web-based systems for the public presentation of data from P4P programs will be demonstrated - as well as their role in enhancing healthcare delivery through the creation of a transparent set of quality indicators enabling comparison between providers and healthcare organizations - will be discussed. Finally, we will describe and discuss HIT support for current attempts for P4P programs in Israel, both by the Ministry of Health and various HMOs.

Biographies Dr. Zeev Aharonson, MD, Medical Director, Meuhedet Health Services

Education: Medical Doctor (M.D.) – The Hebrew University, Hadassah School of Medicine, Jerusalem. Specialist in Orthopedic Surgery and in Healthcare Management Academic Positions: 1979 Instructor in Orthopedic Surgery, Tel Aviv University, Medical School. 2000-2004 Visiting Lecturer, The Health System in Israel, Tel-Aviv University. Employment History: 1989-Today Medical Director and Head of the Medical Wing, Kupat Holim Meuhedet. (Meuhedet HMO). 1987-1989 Senior Physician, Beit Levinstein Hospital, Ra’anana. 1985-1987 Medical Director, Youth Department (28 rehabilitation beds), The Center for Handicapped Children, The Hugh MacMillan Medical Center, Toronto, Canada 1983-1985 Medical Officer, Chief Medical Officer, Southern Command (Full Colonel), Israeli Defense Force (IDF). Secondary appointment: Commander of a Medical Regiment, Shlom Hagalil War. Additional appointment: Chairman of the IDF Supreme Appeal Committee. 1976-1980 Second part of the Orthopedic Surgery internship, The “Sheba” Medical Center, Tel Hashomer. 1975-1976 Deputy Chief Medical Officer of the Central Command, IDF. 1973-1974 First part of the Orthopedic Surgery internship, The General Surgery Department, Ziv Hospital, Safed. Secondary appointment: Commander of a Front Medical Company, Yom Kippur War. 1972-1973 Brigade Physician, Ramat Hagolan, IDF. 1971-1972 Battalion Physician, Sinai, IDF.

Prof. Alexander Aviram , Scientific Director, NIHP

1961- MD Hebrew University Specialist in Internal Medicine, Nephrology and Medical Management. Formerly head, Department of Nephrology and of Rokach ("Hadassah") Hospital, T.A. Associate Director – General of Hadassh Medical Organization, Jerusalem. Director – General of Assuta hospital, T.A. Medical Director, Maccabi health Services. Currently Scientific Director, The Israel National Institute for Health Services and Health Policy Research. Prof. Gabriel Barbash, Director General, Tel Aviv Sourasky Medical Center

Professor Gabriel Barbash, M.D., is a graduate of the Hadassah Medical School of the Hebrew University, Jerusalem, and is board certified in Internal Medicine, Medical Management, and Occupational Medicine. In 1985 he received a Master's degree in Public Health (MPH) - specializing in Health Policy and Management from The School of Public Health of Harvard University. Since 1993, he served as Director General of the Tel-Aviv Sourasky Medical Center, a major teaching hospital affiliated with Tel Aviv University. From 1996 – 1999, he served as the Director General (Surgeon General) of the Ministry of Health. From 1998 to 2000, he was the Chairman of the Israeli Transplant Center. From 1989 through 2000, he served as the National Coordinator and Principal Investigator in Israel for several of the multi-center multi-national clinical studies. In 2001, he was appointed Professor of Epidemiology and Preventive Medicine in The Sackler School of Medicine, Tel Aviv University. Dr. Barbash has published more than 80 original papers - mainly in the fields of diagnosis, risk assessment, and the treatment of acute myocardial infarction.

Dr. Robert A. Berenson, M.D. University of North Carolina School of Public Health and the Fuqua School of Business at Duke University

Robert A. Berenson, M.D., F.A.C.P., is a Senior Fellow at the Urban Institute and adjunct professor in the School of Public Health at The George Washington University School of Medicine, and The Fuqua School of Business at Duke University. He currently focuses policy research on Medicare-related issues, including physician payment reform, chronic care management, contracting with private plans, coverage and payment policy for new technology, health delivery system reform options, and on malpractice issues. Effective as of July of 2009, Dr. Berenson was appointed as Commissioner of the Medicare Payment Advisory Commission (MedPAC). From April of 1998 until October of 2000, he was Director of The Center for Health Plans and Providers in The Centers for Medicare and Medicaid Services (CMS). CHPP was the focal point for payment policy and operational issues related to managed care (Medicare + Choice) plans and healthcare providers. In October of 2000, he became the Acting Deputy Administrator of CMS and, in that position, he served as the senior official in the agency for the last five weeks of the Clinton Administration. Earlier in his career, Dr. Berenson spent three years on the Carter White House Domestic Policy staff, working on national health policy issues. In 1993, Dr. Berenson co-chaired two working groups as part of the Clinton White House Task Force on Healthcare Reform. He recently served as a member of the CMS Agency Review Team for the Obama Transition. Dr. Berenson is a board-certified internist who practiced for more than 20 years, including twelve years in a Washington, D.C. group practice, and has served on numerous medical panels and committees - including the Health and Public Policy Committee of the American College of Physicians. From 1993-1996, He was ACP’s representative to the Resource Based Relative Value Scale Committee (the RUC). He was also National Program Director of IMPACS - Improving Malpractice Prevention and Compensation Systems - a grant program funded by the Robert Wood Johnson Foundation, from 1994-1998. Dr. Berenson came to HCFA from The Lewin Group, where he was a Vice President. For a decade until 1997, he was a co-founder, Board member, and Medical Director of the National Capital Preferred Provider Organization (NCPPO) - a rental-model PPO then serving about 150,000 persons in the Washington, D.C. area. He has published widely in nationally recognized journals, including Health Affairs , New England Journal of Medicine, Annals of Internal Medicine, and Journal of the American Medical Association . In 1998, he co-authored with Walter Zelman - The Managed Care Blues & How to Cure Them - which was published by Georgetown University Press. In 2006, he co-authored with Rick Mayes - Medicare Payment Policy and the Shaping of U.S. Healthcare – which was published by Johns Hopkins University Press. Dr. Berenson is a graduate of Brandeis University (Bachelor of Arts) and Mount Sinai University School of Medicine (M.D.) and he is a Fellow of the American College of Physicians. Prof. Rafael Beyar, Director, Rambam Health Care Campus

Professor Rafael (Rafi) Beyar, born in Tel Aviv in 1952, graduated from the School of Medicine of Tel Aviv University in 1977 (MD), the Faculty of Biomedical Engineering at Technion in 1983 (DSc), and the Bloomberg School of Public Health of Johns Hopkins University in 2008 (MPH). In 1983, he founded the Heart System Research Center at The Technion where he served as Coordinator and Director. He completed his residency in medicine at Rambam (1983-1985) and a fellowship in cardiology at Johns Hopkins University (1985-1987). He was appointed Professor of Biomedical Engineering and Medicine at The Technion in 1996 and served as Director of the Division of Invasive Cardiology at Rambam. He served as Visiting Professor at Johns Hopkins University for several years. In 1998, he was elected as Dean of the Rappaport Faculty of Medicine at The Technion and served for the full term. Under his leadership, members of The Rappaport Faculty of Medicine at The Technion Professor Avram Hershko and Professor Aaron Ciechanover, were awarded the Nobel Prize in Chemistry in October of 2004. Professor Beyar has received prestigious prizes over the course of his career, among them The Taub Prize for Excellence in Research in 1999 and The Michelle Mirowski Award for Accomplishments in Cardiovascular Medicine, The Israeli Heart Association in 2002. In 2005 he was nominated to the prestigious Johns Hopkins Society of Scholars for his worldwide contribution to cardiovascular science and for establishing the Technion-Johns Hopkins Collaboration Program on Biomedical Sciences and Engineering. Beyar’s research and clinical interests range from mathematical simulation to imaging and analysis of the cardiovascular system - as well as the development of stents and new technology in cardiology. He has authored over 150 scientific publications and 11 books, is founder and editor of the Acute Cardiac Care Journal endorsed by the European Society of Cardiology, and is organizer and founder of leading professional cardiovascular meetings. Since February of 2006, Beyar has been serving as General Director of the Rambam Healthcare Campus in Haifa, Israel - which is the major academic hospital serving Northern Israel. In the summer of 2006, he led the hospital through the second Lebanon War when Rambam was treating patients under fire. Beyar is now spearheading a major development plan in both clinical and research facilities at Rambam, focusing on the combination of medicine, science, and technology that will most benefit patients' healthcare. Prof. Gabi Bin Nun, Heath Systems Management, Ben-Gurion University

Prof. Gabi Bin Nun began his career working as an economist in the Ministry of Health 30 years ago. He worked in various key positions - his last being the Deputy Director General for Health Economics (April 2008). Prof. Bin Nun holds a B.A. degree in Economics and Political Science from the Hebrew University in Jerusalem and a Master's degree in Social Welfare from Brandeis University, Boston, USA. Prof. Bin Nun is one of the founders of the Israel National Institute for Health Policy Research as well as the Gertner Institute. Prof. Bin Nun lectures at Ben-Gurion University, School of Management, Dept. of Health Systems Management and has published books and many articles in these fields Prof. Bin Nun was one of the architects and designers of Israel’s National Health Insurance Law (1995) and since then has played a central role in its implementation and evaluation.

Dr. Yair Birnbaum, Head of Medical Services at the Hadassah Medical Organization

Dr. Yair Birnbaum serves as the Associate Director General of Hadassah Medical Organization and as the Head of Medical Services at the Hadassah Medical Organization, Jerusalem. He completed his medical degree at the Hadassah-Hebrew University School of Medicine and his residency in Pediatrics at the Shaare Zedek Medical Center. He also received an MA degree in Public Administration from Harvard University in 1999 and completed a residency in Medical Management. From 2001 until the end of 2007, Dr. Birnbaum served as the Associate Director General of Hadassah Medical Organization and as the Director of the Hadassah Ein- Kerem Medical Center. Prior to his joining Hadassah Medical Organization; he served as the Deputy Director General of Shaare Zedek Medical Center and the Associate Medical Director of Maccabi Health Care Services. In addition to medical training, Dr. Birnbaum is also an ordained Orthodox Rabbi who wrote his thesis on "The Status of the Physician in Jewish Sources."

Dr. Orna Blondheim, Director, Haemek Medical Center

Dr. Orna Blondheim is the first ever female Director of a hospital in Israel, Leading the Emek Medical Center since 2002. EMC is affiliated with the Rappaport Faculty of Medicine of the Technion, Haifa. Dr. Blondheim is a Pediatrician and Neonatologist. She holds a Masters degree in Health Administration (MHA). EMC serves 500,000 residents of Northeastern Israel and under her leadership became the first hospital in Israel to receive the coveted JCI accreditation for quality of healthcare and patient safety In 2008, EMC was voted the overall outstanding hospital for medical excellence among Clalit Hospitals Network. Dr. Blondheim was chosen by Globe’s Newspaper in 2005 as one of the fifty most influential women in Israeli society

Dr. Janet M Corrigan, PHD, MBA, President and CEO, National Quality Forum

Dr. Corrigan is President and CEO of The National Quality Forum, a private, not-for- profit standard-setting organization established in 1999. The NQF mission includes: setting national priorities and goals for performance improvement; endorsing national consensus standards for measuring and publicly reporting on performance; and promoting the attainment of national goals through education and outreach activities. From 1998 to 2005, Dr. Corrigan was Senior Board Director at the Institute of Medicine (IOM). She provided leadership for IOM’s Quality Chasm Series which produced ten reports during her tenure including: To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century . Prior to joining IOM in 1998, Dr. Corrigan was Executive Director of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Dr. Corrigan received her doctorate in health services research and master of industrial engineering degrees from the University of Michigan, and masters’ degrees in business administration and community health from the University of Rochester. She is the recipient of numerous awards including: IOM Cecil Award for Distinguished Service (2002), American College of Medical Informatics Fellow (2006), American College of Medical Quality Founders’ Award (2007), Health Research and Educational TRUST Award (2007), and American Society of Health System Pharmacists’ Award of Honor (2008). Dr. Corrigan serves on numerous boards and committees including: Quality Alliance Steering Committee (2006 – present); Hospital Quality Alliance (2006 – present), National Center for Healthcare Leadership (2003 – present), the Kaiser Permanente Institute for Health Policy Advisory Board (2004 – present), the National eHealth Collaborative (NeHC) Board of Directors (2008 – present), the eHealth Initiative Leadership Council (2008—present), and the Robert Wood Johnson Foundation’s Aligning Forces for Healthcare Quality (AF4Q) National Advisory Committee (2007 – present).

Dr. Asher Elhayany, Director of Meir Medical Center

Professional Experience 2007 Director, Meir Medical Center, Kfar Saba, Israel. 2001-2007 Director, Central District, Clalit Health Services. 1997-2000 Head, Decentralization Unit, Clalit Health Services Headquarter. 1997 Director, Department of Quality Assurance and Drug Utilization Control, Clalit Health Services Headquarter. 1993-1997 Deputy CEO and Head, Ambulatory Division, Soroka University Medical Center, Beer Sheva, Israel. 1993-2001 Independent Physician, Netivot Clinic. 1988-1992 Deputy Medical Director, Negev District, Clalit Health Services. 1988-1989 Director, Netivot Clinic. 1988 Developed computerized medical chart – Medical Computing Unit, Ben- Gurion University of the Negev. 1987-2001 Physician, Pattish village and Reim Kibbutz. 1984-1986 Residency Internal Medicine Department, Soroka University Medical Center, Beer Sheva. 1983-1984 Director, Netivot Clinic 1981-1983 Primary Care Physician, Netivot Clinic. Education 2005 Directors Course. The Israeli Management Center. 1996 TQM in Health Systems Course. Industrial Engineering Dept, Ben-Gurion University ofn the Negev, Beer Sheva. 1992-1993 Master in Public Administration (MPA). John F. Kennedy School of Government, Harvard University, Cambridge MA. 1992(Feb.) Advanced Trauma Life Support Course. 1991(4 mon) Quality in medicine Course, Continuing education training. Edinburgh University, Scotland General Medicine Dept., Supervisor Professor Howie 1990-1991 MPH (Mention of excellence), School of Public Health, Hebrew University, Jerusalem. 1990 Primary Care in the 90's workshop. Glasgow, Scotland 1990 Teaching the Teachers workshop. McGill University faculty, Eilat, Israel. 1986 Completed project on Hypnosis Treatment. Ramat-Hen Clinic, Israel (under Dr. Kleinhaus). 1985 (April) Bat-Sheva Decision Making workshop. Ben-Gurion University of the Negev, Beer Sheva. 1984-1988 Residency in Family Medicine. Soroka University Medical Center, Beer Sheva (Mention of excellence). 1984 Teaching the Teachers workshop. University of Western Ontario, London, Ontario. 1974-1980 Goldman School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel (First cycle program). Public Activities 2007 Board of Trustees Member, the Israel National Institute for Health Policy and Health Service Research. 2006- 2008 Chairman, National Council of Community Health 2002 Member, Social Policy in Israel Research Center. 1996-2006 Chairman, National Committee of Standards of Health in the Community. 1977 Foundation and Organization Member, Perah Project, Ben-Gurion University of the Negev. 1975-1981 Member, National Higher Education Council. Military 1970-1974 Compulsory military service, Israel Defense Army. Discharge rank: First Lieutenant. Reserve Duty Rank: Lieutenant Colonel.

Prof. Miriam Erez, Coordinator of The Status of Women at the Technion

Miriam Erez is the Mendes France Professor of Management and Economics, Faculty of Industrial Engineering & Management, Technion, Israel. She was Faculty Dean and she is currently the Coordinator of The Status of Women at the Technion. She is the recipient of The Israel Prize in Management Sciences, 2005, and the 2002 International Association of Applied Psychology Award “for the Distinguished Scientific Contributions to the International Advancement of Applied Psychology ”. Erez's research is in three major areas: a) Work motivation – in particular on goal-setting theory and performance improvement in various sectors - including in R&D and in the Healthcare sector. b) Cross – cultural organizational behavior – she pioneered in introducing cross-cultural aspects into organizational behavior. c) Innovation in organizations - studying the effects of the individual, the team and the organizational factors on innovation. She established The Knowledge Center for Innovation, supported by the Ministry of Science. Erez published over eighty articles and book chapters and co-authored and co-edited a number of books on culture and work. She advised over 80 graduate students and received numerous research grants from foundations in Israel, the U.S.A., Germany, and Hong Kong. Erez is the former editor of: Applied Psychology: An International Review and the past president of Division-1 of Organizational Psychology, IAAP. Erez is a Fellow of: SIOP, APA, The Academy of Management (AOM), and IAAP.

Dr. Ronni Gamzu, Director of the General Hospital, Tel Aviv Sourasky Medical Center

Education 1988-1990 Ben-Gurion University, Medicine 1990-1994 Sackler School of Medicine, Tel Aviv University, Medicine 1992 Tel Aviv University, B.Med.Sc 1993-1996 Ph.D. Studies: Physiology and Pharmacology Department, Sackler School of Medicine, Tel Aviv University; 1993 The Israel Ministry of Health, Academic Laboratory Technician 1996-1997 Tel Aviv Sourasky Medical Center, Internship 1996 Ph.D.: Tel Aviv University 1996-1997 Tel Aviv University, Health Administration 1997 M.D.: Tel Aviv University 1997-2002 Lis Maternity Hospital, Resident, Obstetrics and Gynecology 1998 Tel Aviv University, MSc-Master’s Postgraduate Degree Obstetrics and Gynecology 1998 MHA - Master in Health Administration, Recanati School of Business Administration, Tel Aviv University 2002 MBA - Master in Business Administration, Recanati School of Business Administration, Tel Aviv University 2002-2008 Deputy Director Health Economics, The Tel Aviv Sourasky Medical Center 2002 Specialist in Obstetrics and Gynecology 2003-2005 Residency: Medical Management, Israel Ministry of Health 2004-2008 Studies towards Law (L.L.B.) degree, The Buchmann Faculty of Law, Tel Aviv University 2006 Approved Medical Manager, Israel Ministry of Health 2008 European Health Leadership Program, INSEAD, Fontaibleu, France 2008 LL.B, Tel Aviv University 2008 Director of the General Hospital, The Tel Aviv Sourasky Medical Center Academic and Professional Experience 1996-1997 The Israeli College, Tel Aviv, Health Administration Lecturer 1996-1997 Tel Aviv University, Tel Aviv, External section Lecturer 1997-2002 Resident, ObGyn, Lis Maternity Hospital, Tel Aviv Medical Center 1999 Tel Aviv University, Tel Aviv, Sackler School of Medicine, Obstetrics and Gynecology Instructor 2002 ObGyn-Board Examination-Cum Laude 2002-2003 Obstetrician at Leumit and Meuchedet Health Services 2000-2002 Laniado School of Nursing, Netanya, Lecturer 2003 Tel Aviv University, Tel Aviv, Sackler School of Medicine, Obstetrics and Gynecology, Senior Lecturer 2003 Senior Gynecologist (at 1/6 part-time occupation), Lis Maternity Hospital. Dr. Eyran Halpern, Chief Executive Officer, Rabin Medical Center

Dr. Eyran Halpern, an alumnus of Hebrew University – Hadassah School of Medicine, also holds a Master's Degree in Public Administration (MPA) from The Kennedy School of Government at Harvard University (1989). Upon completion of his residency in Internal Medicine, Dr. Halpern joined the administrative staff of HaEmek Hospital in Afula, a Clalit Health Services hospital in the north of the country - where he served four years as Deputy Director. In the years to follow, Dr. Halpern held various senior level positions within Clalit, including Head of Western Galilee and Haifa District (600,000 insurees). In the year 1997, Dr. Halpern returned once more to HaEmek Hospital, this time as the CEO. During his five years in this position, the hospital dealt with repeated multi-victim terrorist attacks and placed great efforts in improving the capabilities and readiness for multi-trauma events. The hospital also underwent significant growth and development. From 2002-2007, he served as Deputy Director General of Clalit with responsibility over all Clalit hospitals nationwide. Since February 2007, Dr. Halpern holds the position of Chief Executive Officer (CEO) of Rabin Medical Center, Clalit’s flagship hospital. Notable Achievements • Consolidated numerous small laboratories scattered throughout the Western Galilee and Haifa region into one modern facility. • Established the most comprehensive ambulatory center in Israel (Zevulun). • Developed and modernized Haemek Hospital including main hospitalization tower and a new emergency department. • Implemented information systems in the hospital administration of all Clalit Hospitals • Initiated J.C.I. accreditation standards and guidelines for all Clalit Hospitals. • Established a Central Research Review Department to ensure proper process of clinical and basic trials within the Clalit H.M.O.

Dr. Tuvia Horev, PhD, Deputy Director General of Finance, Ministry of Health

Dr. Horev is the Deputy Director General of Health Economics and Health Insurance in the Israel Ministry of Health. Dr. Horev received his D.M.D. and M.P.H. from the Hebrew University – Hadassah Hospital in Jerusalem, and his Ph.D degree from the Department of Health Policy and Management in Ben-Gurion University of the Negev, Beer Sheva. Dr. Horev served in several commanding duties in the IDF (the Israeli Defense Forces), among them - Chief Dental Officer of the IDF (1992-1995). Between 1995 and 2006 he served both as the senior advisor on Health Administration to the General Manager of Kupat Holim Meuhedet (one of 4 Israeli's sick funds) and Head of the Health and LTC insurance section at this Sick Fund. In this position he has had the opportunity to examine, first hand, the evolution of the health reform law in Israel since it was enacted in 1995 - and to study its advantages and challenges. Between 2006 and 2009, he served as a senior researcher and deputy general manager at the Taub Center for Social Policy Studies in Israel. His main areas of interests and research are Health Policy, Health Equity, Health Insurance, and Health economics He is a faculty member in the Department of Health Policy and Administration at Ben-Gurion University of the Negev, and in constant relations with the Israel National Institute for Health Policy and Health Services Research in Israel.

Prof. Avi Israeli, Director General, Ministry of Health

Prof. Avi Israeli has been Director-General of the Israel Ministry of Health since 2003. He also holds the Dr. Julian Rozan Chair in Family Medicine and Health Promotion at The Hebrew University Hadassah Medical School, Jerusalem (since 1996) and still teaches regularly there. From 1998-2001, he was Director-General of the Hadassah Medical Organization and Hadassah Hospital. His scientific activities are associated with applied, methodological, and theoretical research in the fields of health policy, health care management, and the epidemiological, economic, social, and cultural bases for decision-making. The general approach of all his work is to translate academic knowledge into changes to the policy setting and decision-making processes. Two key research foci are rationing/priority setting and comparative healthcare systems. His work in these fields has gained him an international reputation and he is invited to the most senior international forums and advisory bodies.

Mr. Charles N. Kahn, President, Federation of American Hospitals

Charles N. (“Chip”) Kahn III is one of the nation’s most notable and quotable experts on health policy, Medicare payment, healthcare financing, and the uninsured. Since June 2001, he has served as President of the Federation of American Hospitals (FAH) - the national advocacy organization for investor-owned hospitals and health systems. Mr. Kahn is one of only 17 healthcare leaders who have appeared on Modern Healthcare magazine’s annual “100 Most Powerful People in Healthcare” list since its inception. In May of 2008, The Hill newspaper selected him as one of the capital’s top lobbyists for the eighth consecutive year. Mr. Kahn is at the forefront of national initiatives to shape policy for healthcare quality and information technology. In June 2007, he was appointed to the Governing Board of the National Quality Forum (NQF), a not-for-profit private-public partnership and the nation’s preeminent organization for developing and implementing a national strategy for healthcare quality measurement. Mr. Kahn also serves as a principal in the Hospital Quality Alliance (HQA), a private- public partnership that he helped to initiate and served as a Commissioner of the American Health Information Community - a former federal policy advisory panel. Before coming to the FAH, Mr. Kahn was one of the nation’s top leaders in the health insurance industry. From January 1998 to June 2001, while President of the Health Insurance Association of America (HIAA), he focused national attention upon the plight of the uninsured. Mr. Kahn has a long and distinguished career as a professional staff person on Capitol Hill, specializing in health policy issues. During 1995-1998, he served as staff director for the Health Subcommittee of the House Ways and Means Committee. From 1986- 1993, Mr. Kahn served as minority health counsel for the House Ways and Means Health Subcommittee. Earlier in his Capitol Hill career, he served as senior health policy advisor to former Senator David Durenberger (R-MN) and legislative assistant for health to former Senator Dan Quayle (R-IN). Mr. Kahn holds a Master's of Public Health (M.P.H.) degree from Tulane University School of Public Health and Tropical Medicine and a Bachelor of Arts degree from The Johns Hopkins University.

Dr. Ehud Kokia, Director General, Maccabi Healthcare Services

Born in Israel. 1974 - Graduate of The Sackler School of Medicine, Tel Aviv University (Cum Laude). Board certified OBGYN. Research fellowship: 2002 - MHA, Ben-Gurion University of the Negev 1990 - 1992 - University of Maryland in Baltimore Current Position: CEO - Maccabi Healthcare Services (MHS). Former Positions: Medical Director - Maccabi Healthcare Services Hanegev District Manager - Maccabi Healthcare Services General Director - Ramat Marpe, Hospitol, Petach Tikva, Israel Military Service: Commander - Israeli Air Force Aeromedical Center.

Dr. Nicky Lieberman, Chairman, Medical Department, Clalit Health Services

In 1987 (before the end of my residency period), I was named Deputy Director of Meir Hospital – a medium-size general hospital in the center of Israel - and was part of the management that led this hospital from 440 beds to a >700 bed facility. In this function, I introduced risk management, quality assessment, and management. In 1993, I became Medical Director of the Sharon-Shomron District, the 2nd largest district of the largest HMO in Israel. In this district, I promoted interventional programs in drug management according to pharmacoeconomic principles and led programs promoting quality in medical interventions. In 1998, I was named Head of the Community Medical Division and Planner of the Medical, Pharmaceutical, and Technological policy of the HMO (community and Hospitals – together). Since 2000, I was part of the National Technologies Committee – advising the M.O.H. on the preferred technologies and drugs to be added to the national basket. Since 1998, I led different interventional programs – such as The Diabetes Clalit Program, Vita Longa (secondary prevention in CHD), the CHF program – an HMO wide interventional program of disease management of severe CHF patients, "4C" – primary prevention of high risk patients etc…. Prof. Shlomo Mor-Yosef, Director General, Hadassah Hospital

Shlomo Mor-Yosef is the Director General of the Hadassah Medical Organization since 2001. He graduated from the Hebrew University Hadassah Medical School in 1980 - completing his obstetrics and gynecology specialization at the Hadassah University Medical Center at Ein Kerem in 1987. In 1989, Prof. Mor-Yosef completed a subspecialty in Gynecological Oncology in England. In 1994, Prof. Mor-Yosef completed his studies at Harvard University where he received a Master’s Degree in Public Administration from the John F. Kennedy School of Government. Prior to his current appointment as Director General, Prof. Mor-Yosef served as CEO of the Soroka Medical Center in Beer Sheva. Prof. Mor-Yosef has directed many medical education programs and was a fellow at the Harvard University Institute of Economics and Social Policy of the Middle East. He has authored more than 100 scientific publications and has served on the faculty of several universities and the boards of various organizations and companies. Among his present responsibilities, Prof. Mor-Yosef is Chairman of Hadasit - the Technology Transfer Company of Hadassah Medical Organization, and serves as Chairman of the Board of the Israel National Institute for Health Policy and Health Services Research.

Dr. Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI, President, Clinical Services and Chief Medical Officer

Dr. Jonathan B. Perlin is President, Clinical Services and Chief Medical Officer of the Nashville, Tennessee-based HCA (Hospital Corporation of America). He provides leadership for clinical services and the improvement of performance at HCA’s 166 hospitals and 168 outpatient centers. Current activities include implementing electronic health records throughout HCA, improving clinical “core measures” to benchmark levels, and leading patient safety programs to eliminate preventable, drug resistant, healthcare- associated infections. Before joining HCA in 2006, Dr. Perlin was Under Secretary of Health in the U.S. Department of Veterans Affairs. Nominated by the President and confirmed by the Senate, as the senior-most physician in the Federal Government and Chief Executive Officer of the Veterans Health Administration (VHA), Dr. Perlin led the nation’s largest integrated health system. At VHA, Dr. Perlin directed care to over 5.4 million patients annually by more than 200,000 healthcare professionals at 1,400 sites, including hospitals, clinics, nursing homes, counseling centers, and other facilities, with an operating and capital budget of over $34 billion. A champion for the implementation of electronic health records, Dr. Perlin led VHA quality performance to international recognition as reported in academic literature and lay press - and as evaluated by RAND, the Institute of Medicine, and others. Dr. Perlin has served on numerous Boards and Commissions including the National Quality Forum, the Joint Commission, Meharry Medical College, the National eHealth Collaborative, and he chairs the HHS Health IT Standards Committee. Broadly published in healthcare quality and transformation, he is a Fellow of the American College of Physicians and the American College of Medical Informatics. Dr. Perlin has a Master’s of Science in Health Administration and received his Ph.D. in pharmacology (molecular neurobiology) with his M.D. as part of the Physician Scientist Training Program at the Medical College of Virginia of Virginia Commonwealth University (VCU). Recognized as one of the 10 most influential physician executives in the United States by Modern Healthcare , Dr. Perlin has received numerous awards including Distinguished Alumnus in Medicine and Health Administration from his alma mater , the Founders Medal from the Association of Military Surgeons of the United States, and is one of nine honorary members of the Special Forces Association and Green Berets. Dr. Perlin has faculty appointments at Vanderbilt University as Adjunct Professor of Medicine and Biomedical Informatics and at VCU as Adjunct Professor of Health Administration. He resides in Nashville, Tennessee, with his wife, Donna, an Emergency Pediatrics Physician, and children, Ben and Sarah.

Prof. Avi Porath, Medical Director, Maccabi Healthcare Services

Education: 1977 M.D., Hebrew University, Hadassah Medical School, Jerusalem 1985 Board Certification in Internal Medicine 1987-1988 Master's in Public Health, Department of Epidemiology, the University of North Carolina at Chapel Hill, USA 1-6/1989 Clinical decision making, Division of Clinical Decision Making, Department of Medicine, Tuft's Medical Center, Boston, Massachusetts Jun 1994 Continuous Quality Improvement, Maastricht University, Holland Aug 1994 Continuous Quality Improvement, Institute for Healthcare Improvement, Boston, Massachusetts Employment: 2008-present Medical Director, Maccabi Healthcare Services 1995-2008 Director, Department of Medicine “F”, Soroka Medical Center 1997-2008 Director, Department of Medical Policy in the Community, Clalit Health Services Professional Activities: 1. Academic appointments: 2001 Professor of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev 2. Professional functions: 2004 Member of The Administrative Council of the European Federation of Internal Medicine 2004-2009 Director of the National Program of Quality Indicators for Community Healthcare in Israel, the Ministry of Health

Dr. Ehud Raanani, Director of Cardiac Surgery, Sheba Medical Center

Dr. Ehud Raanani was born in Ghana in 1962 and immigrated to Israel as a child. After completing a clinical fellowship program in the Department of Surgery at the Toronto General Hospital in 2000, he became a staff surgeon and later head of the Aortic Surgery Program at the Rabin Medical Center in Israel. After successfully completing several postgraduate courses both in Europe and the USA, he was appointed Head of the Cardiothoracic Surgery Department at The Chaim Sheba Medical Center in 2004, and in 2005 became Chairman of the Israel Society for Cardiothoracic Surgery. In 2007 he became senior lecturer in the Department of Surgery at The Sackler Faculty of Medicine of the Tel Aviv University. Dr. Raanani has published over 50 peer reviewed articles, as well as chapters in books and has actively participated in prestigious national and international symposia, such as The European Society for Cardiovascular Surgery, the Society for Thoracic Surgeons, the World Congress of Anaesthesiologists, and The Society for Heart Valve Disease. In 2007, Dr. Raanani became a cardiac surgery specialist and medical consultant.

Dr. Joseph K. Rosenblum, Director of Medical Information, Meuhedet Health Services

1972 – 1978 The Sackler School of Medicine, Tel Aviv University, M.D. diploma 1978 – 1979 Internship, Shaarey Zedek Hospital, Jerusalem 1979 – 1983 Military surgeon, I.D.F. Medical Corps. 1983 – 1998 Head of the clinical computing department, Sheba Medical Center, Tel Hashomer 1983 – 1997 V.P. of Research and Development, Computerized Medical Technologies ("COMET" Inc.), Tel Aviv 1986 – 1987 Creation and formation of the Information & Computing division of the I.D.F Medical corps. Discharge rank: Lieut. Colonel Since 1998 Lecturer, The Sackler School of Continuing Medical Education, Tel Aviv University Since 1994 Lecturer, The Israeli Extension of Clark University, New England 1998 – 2000 Head of the Department of Medical Informatics, The Gertner Institute for Epidemiology and Medical Research, Tel Hashomer Hospital Since 2000 C.I.O. of the Medical Division, Kupat Holim Meuhedet, Tel Aviv

Prof. Yair Shapiro, MD, MBA, MPH, FACSM, C.E.O., Assuta Medical Center

A. Education: 1958-1965 Hadassah Medical School, Hebrew University, Jerusalem, Israel. 1966 M.D. Degree B. Further Studies: 1971-1974 MBA – Tel Aviv University 1980-1982 Medical Administration for Senior Physicians (Diploma). Haifa University, Israel 1992 MPH – Hebrew University Medical School, Jerusalem, Israel. 1993 Advanced Management Program, Harvard Graduate School of Business, Boston, M.A., USA Specialization: Occupational Medicine , Public Health, Medical Management, and Health Management. C. Academic Experience: 1968-1978 Senior Lecturer of Environmental Physiology and Medicine, School of Military, I.D.F. Medical Corps. 1971-1974 Instructor, Physiology and Pharmacology, Tel Aviv University Sackler School of Medicine. 1975-1977 Lecturer, Department of Physiology and Pharmacology, Tel Aviv University Sackler School of Medicine. 1983-1985 Senior Lecturer, Department of Physiology and Pharmacology Tel Aviv University Sackler School of Medicine. 1983-1985 Associate Professor in Physiology Medical School, Ben-Gurion University of the Negev. Since 1986 Professor, Faculty of Health Sciences, Ben-Gurion University of the Negev. 1986-1995 Professor, Department of Physiology and Pharmacology, Tel Aviv University Sackler School of Medicine. Since 2000 Professor, School of Health Sciences, ARIEL University center. Since 2002 Dean, School of Health Sciences, ARIEL University center. D. Clinical Experience: 1966 Internship, Tel Hashomer Hospital, Israel. 1983-1986 Medical Director, Soroka Medical Center, Beer-Sheva, Israel. (700 beds, University General Hospital) 1987-1988 Medical Director, Beilinson Medical Center, Petah Tikva, Israel. (1000 beds, University General Hospital). 1988-1992 Medical Director of Kupat Holim (3 million member sick fund). Since 1993 Director General, Assuta Medical Center. Present Position A . C.E.O. Assuta Medical Centers, Israel B . Director of Heller Institute of Medical Research, Sheba Medical Center, Tel Aviv University Sackler School of Medicine. C . Dean School of Health Sciences, ARIEL University center. Prof. Joshua Shemer, Chairman, Assuta Medical Center

Born in Israel and a graduate of the Hebrew University and Hadassah School of Medicine.

Current position: 1. Full Professor, Internal Medicine, Sackler Faculty of Medicine, Tel Aviv University 2. Director, Israeli Center for Health Technology Assessment in Healthcare (ICTAHC), The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 3. Chairman, Assuta Medical Centers in Israel 4. Chairman, Maccabi Institute for Health Services Research 5. Head, School of Public Health, Tel Aviv University 6. Deputy Chairman, Board of Directors, Maccabi Healthcare Services 7. Associate Editor of the Israel Medical Association Journal (I.M.A.J.) (English) 8. Associate Editor of Harefuah, Journal of the Israel Medical Association (Hebrew) 9. Member, Editorial Board of the International Journal of Technology Assessment in Healthcare (I.J.T.A.H.C.) Leading Former Positions: • Surgeon General of the Israel Defense Forces Medical Corps holding the rank of Brigadier General (1994-1997) • Director-General of the Ministry of Health (1999-2000) • Director-General, Maccabi Healthcare Services (2001-2007) • Maccabi the second largest non-profit HMO in Israel with 1.8 million members, 9,000 employees, 3,500 physicians, more than 3,500 clinics and pharmacies and a budget of $1.8 billion • Member and former Chairman of the National Public Committee for Updating the National List of Health Services in Israel • Member and former Chairman of the National Council for Trauma • Chairman and member, Supreme Health Authority for Emergency Situations, Ministry of Health, Israel (1989-2007) • Founder & Chairman, National Council for Logistics in Health Services, Ministry of Health, Israel (1994-2000) • Active membership on several national and international committees and professional organizations • Alumnus, National Institutes of Health (N.I.H.), Bethesda, Maryland, U.S.A. (1984-1987, 1991-1992, 2001) Professor Shemer has actively participated in over a hundred national and international scientific meetings abroad. Prof. Shemer’s academic activities include over 200 publications in prominent professional peer reviewed publications including 6 books edited in the fields of trauma, health reforms, medical technology, management, bioterrorism, and over 20 chapters in several books. Prof. Elisheva Simchen, Department of Health Services Research, Ministry of Health

Education and Degrees 1960 – 1963 Medical School, The Hebrew University of Jerusalem 1963 – 1967 Continued medical training at Queen Elizabeth University Hospital, University of Birmingham, England 1967 M.B., Ch.B., University of Birmingham, England 1967 – 1968 Internship at the Hadassah Hospital, Jerusalem. 1968 – 1970 Career interruption due to child rearing. Working as a physician in the emergency service of Magen David Adom. 1970 – 1971 Training in Public Health. Joined the first International M.P.H. class at The Hebrew University, Jerusalem. 1971 – 1973 Training in Epidemiology at the School of Public Health, University of Washington, Seattle, Washington. 1973 M.P.H., The Hebrew University Medical School, Jerusalem. The Hadassah – Hebrew University Appointment 1992 Associate Professor in Public Health, Medical School, The Hebrew University of Jerusalem. 1993 – 1996 Director, The Braun School of Public Health, Hebrew University and Hadassah, Jerusalem . 2003 1st of September. Retired from Hadassah Hospital and The Hebrew University of Jerusalem. Major National Assignments 1982 – 1994 Appointed by the Director General, Ministry of Health, as Head of The Unit for the Study and Control of Hospital Acquired Infections. 1987 Member, National Committee on Vaccination Policy. 1989 – 1990 Member, Advisory Committee to the Director General, Ministry of Health, on guidelines for the control of infection in operating theatres . 1989 Member, Advisory Committee to the Director General, Ministry of Health, on the use of anaesthetic compounds in Israeli hospitals . 1993 – 1996 Director, The Braun School of Public Health, Hebrew University and Hadassah, Jerusalem (then, the only School of Public Health in the country). 1994 Appointed by the Director General of the Ministry of Health, as head of a new department, for the “Study of Health Services,” (replacing the unit for the Study of Hospital Acquired Infections). 1996 Appointed member of the National Council on Primary Healthcare. 1999 Invited speaker on “Scientific Evidence and Quality of Care Policy,” The 1 st Annual Conference on Health Policy - by the Israel National Institute for Health Policy Research. 1999 Member of the Research Board of the Israel National Institute for Health Policy Research. 2000 Opening the plenary session with a lecture on “Determination, Implementation, and Evaluation of Health Targets for Israel”, The 2 nd Annual Conference on Health Policy - by the Israel National Institute for Health Policy Research. 2000 Appointed Head of The Organizing Committee for The 2 nd Annual Conference on Health Policy - by the Israel National Institute for Health Policy Research . 2001 Appointed by the Director General, Ministry of Health, as a member of the consensus conference on “updating the need for intensive care beds in Israel” 2002 Appointed as a member of The Board of the Israel National Institute for Health Policy Research. 2003 Appointed by the Director General of the Ministry of Health to a national committee on “Setting Long Term Health Goals for Israel.” 2008 Assigned by the Director General of the Ministry of Health to lead a study on the quality of care in general and orthopedic surgery in all 21 hospitals with intensive care units in the country. The study is held over the course of 2009-2010 and is planned as an ongoing project.

Dr. Paul C. Tang, M.D., M.S., Chief Medical Information Officer , Vice President , Palo Alto Medical Foundation

Department(s) and Specialty: Internal Medicine Medical Education: University of California, San Francisco, 1981 Internship and Residency: Stanford University Medical Center, CA Affiliations: Elected Institute of Medicine member, American College of Physicians, American College of Medical Informatics, College of Healthcare Information Management Executives, American Medical Informatics Association (Immediate-Past Board Chair), Institute of Medicine's Health Care Services Board, National Committee on Vital and Health Statistics, Institute of Medicine Committee on the Future Healthcare Workforce for Older Americans, American Health Information Community Consumer Empowerment Work Group, National Quality Forum Consensus Standards Approval Committee, National Quality Forum Health Information Technology Expert Panel (Chair), Quality Alliance Steering Committee Measurement Implementation Strategy Committee (Co-Chair), Robert Wood Johnson National Advisory Council (Chair) on Personal Health Records, Markle Foundation Connecting for Health, Center for Information Technology Leadership. Personal & Practice Philosophy Information: Paul Tang, M.D., M.S., is a consulting associate professor at Stanford University School of Medicine. At PAMF, Dr. Tang is responsible for clinical information systems, including an enterprise-wide electronic health record system and an integrated personal health record system. He received his B.S. and M.S. degrees in electrical engineering from Stanford University and his M.D. degree from the UCSF School of Medicine. Dr. Tang is the immediate past chair of The Board for the American Medical Informatics Association and a member of the National Committee on Vital Health Statistics - the federal advisory committee to the Secretary of Health and Human Services Michael Leavitt regarding health information policy - as well as the Consumer Empowerment Workgroup of the American Health Information Community, which Secretary Leavitt chairs. Dr. Tang chairs the Robert Wood Johnson National Advisory Committee on personal health records and the National Quality Forum's (NQF) Health Information Technology Expert Panel, and co-chairs the Quality Alliance Steering Committee Measurement Implementation Strategy committee. He is a member of NQF's Consensus Standards Approval Committee, is an elected member of the Institute of Medicine, and serves on the Health Care Services Board. He chaired the IOM Committee on Data Standards for Patient Safety. He is currently a member of the IOM Committee on the Future Health Care Workforce for Older Americans. Dr. Tang has served on numerous committees of the National Institutes of Health, National Research Council, National Academy of Sciences, Institute of Medicine, and Computer Science and Technology Board. He is a fellow of the American College of Physicians, American College of Medical Informatics, College of Healthcare Information Management Executives, and Healthcare Information and Management Systems Society. Prof. Gideon Uretzky, Chairman, Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center

Education: 1964-1970 Medical School, Hebrew University, Ein Kerem, Jerusalem. Residency: 1974-1980 Residency in Cardiothoracic Surgery, Hadassah Medical Center, Ein Kerem, Jerusalem. Specialization: Specialist Cardiothoracic Surgeon. Fellowships Abroad: 1980-1982 Advanced training at the Mayo Clinic, USA, in cardiothoracic surgery, as well as a research fellow at the University Hospital of Harvard University, Boston, USA. 1985 Advanced training in valve repair surgery, Paris, France, under the direction of Prof. Carpentier. 1974 Advanced training in Hyperbaric Medicine at the Maritime Medicine Institute of the British Navy. Academic Experience: 1977-1979 Instructor in Surgery, Hebrew University - Hadassah Medical School, Jerusalem. 1979-1983 Lecturer in Surgery, Hebrew University - Hadassah Medical School, Jerusalem. 1982 Research Fellow, Harvard Medical School, Department of Cardiovascular and Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 1983-1987 Senior Lecturer in Surgery, Hebrew University, Hadassah Medical School, Jerusalem. 1987-1993 Associate Professor in Surgery, Hebrew University, Hadassah Medical School, Jerusalem. 1992 Professor of Cardiothoracic Surgery, Technion - Israel Institute of Technology, Haifa. 1994-1996 Member, Rappaport Institute for Research in the Medical Sciences. 2001 Professor of Cardiothoracic Surgery, Sackler Faculty of Medicine, Tel- Aviv University. Clinical Experience: 1974-1980 Residency in Cardiothoracic Surgery, Hadassah University Hospital, Ein Kerem, Jerusalem. 1982-1991 Consultant, Department of Cardiothoracic Surgery, Hadassah University Hospital, Ein Kerem, Jerusalem. 1991-2000 Chairman, Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa. 2000- Present Chairman, Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Membership in Professional Societies: Member of 25 international professional societies. Fellow of American College of Surgeons, Fellow of American College of Cardiology, Fellow of the European Society of Cardiology, Member of Israeli National Council for Cardiovascular Diseases. Professional Publications: Over 160 publications in professional journals, chapters in several professional books and over 290 abstracts. Prizes and Research Grants: Received 37 prizes and research grants.

Prof. Daniel Vardy, Medical Director, Leumit Health Fund

Born in Israel, 1955, married, father of five, resident of Omer.
M.D., Ben-Gurion University, 1983
M.Sc., Ben-Gurion University, 1996
Board certified in Dermatology and Venereology, 1991
Board certified in Medical Management, 1996
Associate Professor of Medicine (dermatology), Faculty for Health Sciences, Ben- Gurion University.
Medical Director of Leumit Health Fund, since 2007
Medical Director of Clalit Health Services Southern District, 2001-2007
Deputy Director of Soroka University Medical Center, 1997-2001
Practicing dermatologist since 1986

Dr. Ahuva Weiss-Meilik, Research Department, Tel Aviv Sourasky Medical Center

Dr. Weiss-Meilik serves as the head of the Clinical Performance unit in the Tel Aviv Medical center. She holds a PhD degree, from the Technion (the Israeli Institute of Technology), in healthcare performance and outcome analysis .

Dr. Julian Zelingher, Director of Medical Planning and Development at the Hospital Division, Clalit Health Services Headquarters, Tel Aviv

Julian (Ilan) Zelingher is the Director of Medical Planning and Development at the Hospital Division, Clalit Health Services Corporate Headquarters, Tel Aviv, Israel. Among his responsibilities in this position are the development, implementation, and evaluation of clinical information systems at Clalit's 14 general and specialty hospitals throughout Israel. Previous to his current appointment, Dr. Zelingher served as Deputy Director General of the Soroka University Medical Center - a 1,000 bed hospital - one of Israel's largest hospitals and a major teaching affiliate of the Ben-Gurion University Medical School in Beer Sheba. Dr. Zelingher joined Soroka in 1996 following completion of a three-year fellowship in Medical Informatics at Harvard Medical School’s Center for Clinical Computing at Beth Israel Hospital in Boston, M.A. He is a graduate of the Hadassah - Hebrew University Medical School in Jerusalem, Israel, and holds an M.P.H. degree in Health Care Policy and Management from the Harvard School of Public Health and a Master of Science degree in Neurobiology from the Hebrew University. He is a diplomat of the Israeli Boards of Internal Medicine and has completed his residency training in Internal Medicine at the Hadassah University Hospital in Jerusalem and a fellowship in General Internal Medicine at the Beth Israel Hospital in Boston, M.A. In addition, Dr. Zelingher is a diplomat of the Israeli Boards of Healthcare Management. As part of his studies at Harvard University, Dr. Zelingher has completed the Program in Clinical Effectivness, a joint program of Brigham and Women‘s Hospital and the Harvard School of Public Health, with emphasis on training in epidemiology, biostatistics, and quality improvement.