The Washington Post

Blazing a legal trail to help improve health care

Ariane Tschumi has spent more than a year in government as a Presidential Management Fellow (PMF), taking on challenging assignments at the Department of Health and Human Services (HHS) designed to develop her leadership skills and give her a window into how government operates.

She has worked alongside health-care experts designing model programs intended to better health care and lower costs, and with attorneys in the Office of the Inspector General (OIG), who are trying to prevent waste, fraud and abuse in the health-care system.

“I’ve learned a good amount through working with top health policy experts inside and those who come in from outside,” said Tschumi, PMF at the Innovation Center at the Centers for Medicare and Medicaid Services (CMS).

“It’s interesting to me the enormous possible gains our health system can achieve and the amount of waste in the health-care system,” Tschumi said. “Studies have shown there is $750 billion in wasted spending due to factors such as unnecessary or inefficiently delivered services.”

Her legal training has been a valuable skill for the Innovation Center, which designs and tests ways of paying for and delivering health care with the aim of improving the health-care experience for patients, bettering health in entire populations and lowering the cost of care.

(Ariane Tschumi)

As the first lawyer to work with the Center, which was created under the Affordable Care Act, she has helped the non-lawyers who are developing new health-care models to understand the legal issues surrounding them, and worked with government stakeholders who want to be sure new programs are consistent with government regulation and law.

“Ariane arrived out of the sky with a newly minted law degree,” said Richard Baron, director of the Seamless Care Models Group at the Innovation Center. “We cast her in the lead role of contacting outside organizations and managing relationships with legal colleagues within government. She winds up in the middle of this fast-moving set of conversations and she was amazing.”

Tschumi currently is on a six-month detail in the OIG, which fights waste, fraud and abuse in Medicare, Medicaid and other federal health programs. She has reviewed documents and evaluated programs to uncover where there might be vulnerabilities and how to mitigate those weaknesses.

She also is helping the inspector general’s office learn and understand the complex regulations and rules surrounding the health insurance exchanges in the new health-care law.

“She is mastering them and teaching us how they work,” said Vicki Robinson, senior counselor for policy at OIG. “She is the first person with legal background brought on board to build a bridge between lawyers and non-lawyers. Hers is almost a translation role, and she’s very effective at that.”

Tschumi said she is motivated by the idea that that the United States has an enormous opportunity to create a system that can reduce waste in health care and improve health outcomes, leading to a strengthened fiscal position for the nation and improved patient health overall.

At the Innovation Center, Tschumi worked on two major projects, one on improving how patient care is coordinated and the other on strengthening and expanding primary care.

She joined the team that is leading an effort to create incentives to encourage health-care providers to work together to manage a patient’s care across all their doctors’ offices, hospitals or other health-care facilities. The goal is to improve health-care quality and outcomes for patients and save costs for Medicare, employers and patients. “The aim is to ensure that patients are receiving the right care, at the right time, in the right place,” Tschumi said.

The model of Accountable Care Organizations (ACO) is intended to reduce the cost of high-quality, patient-centered care, and if these organizations do so, Medicare will share in the savings with the ACO, the physicians and other providers involved.

Tschumi also has been involved in strategy sessions of a Comprehensive Primary Care initiative, which involves public and private health-care payers in seven markets nationwide collaborating to strengthen primary care. She said she finds the program “particularly exciting” because it will inject more resources into primary care practices and help expand care.

During the summer of 2005, Tschumi spent six weeks in Aceh, Indonesia as part of the International Rescue Committee’s tsunami relief efforts. That experience crystalized her interest in public health and how to use holistic strategies to address, all together, pertinent issues such as health care, lack of water and livelihoods.

“I got a greater understanding and appreciation of systems thinking rather than singular intervention,” she said. In this country too, she added, “it’s about how the individual pieces come together to create a functional whole for our health care systems.”

This article was jointly prepared by the Partnership for Public Service, a group seeking to enhance the performance of the federal government, and Go to to nominate a federal employee for a Service to America Medal and to read about other federal workers who are making a difference.

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