James B. Couch, M.D., J.D., FACPE

Dr. Couch has over 30 years of accomplishments in healthcare delivery and management with an emphasis on evaluating, developing and implementing health IT systems to improve the demonstrable quality, safety and value of health care delivery. His work in value based purchasing, and what is now called accountable care, dates to the 1980s.

His most notable accomplishments have been in the use of Advanced Clinical Analytic, Care Management and Population Health Management Systems. For example, he led an unprecedented controlled clinical trial at a major medical center which demonstrated the 700% ROI of an advanced clinical decision support and care management system.  Aetna purchased the company that had developed this system for $400 million three months after a leading academic journal published this study.   The Director of the White House Office of the Management and the Budget (OMB) lauded this study in the July 21, 2009 online edition of the “Washington Post” as an example of how the healthcare reforms being pushed by the Obama Administration could save both lives and money

Dr. Couch has also worked extensively the past seven years in evaluating and positioning leading edge cloud-based electronic health information systems, clinical and population health analytics products for use by top healthcare providers and payers.  He helped to introduce, to present, and to position a leading edge technology company to Humana, which now serves as the core analytics engine for optimizing the quality of care delivered to 12 million Humana members.

Dr. Couch has served as the Chief Medical Quality Officer of a leading academic health system and university hospital and two “Big 5” Health Insurance Companies.  He has also served as the Director in Charge of Disease Management Consulting at a “Big 4” Professional Services firm and as Chief Medical Officer (CMO), VP of Strategy and Leader of Health IT for the American Division of the world’s largest reinsurance company. In all of those roles, he was intimately involved in researching, identifying and overseeing the implementation of best evidence based medical practices both in the U.S. and Abroad.

Working with KPMG, recently, he assisted  NYC Performing Provider Systems to put together their proposals to the NY State Dept. of Health to obtain funding for the next five years to transform the delivery of care in NY.  This is part of the $8 billion New York Delivery System Reform Incentive Payment (DSRIP) Program.

Dr. Couch was the first to publish on value based purchasing (VBP) in 1987. As its Chief Medical Officer, he led the VBP efforts of the American Division of the world’s largest reinsurance company in becoming a Charter Member of the Leapfrog Group.  He also served as a charter member of the Health Policy Council of the National Business Group on Health, promoting VBP to its Fortune 500 company membership.

In 1992, Dr. Couch, the first physician in the country trained at Motorola University in Six Sigma Process Improvement methodologies.  His team uncovered $55 million in waste due to preventable defects identified in Travelers’ (then) 487 step health claims payment process.

From 1992 through 1994, Dr. Couch was also the only physician Senior Examiner for the Malcolm Baldrige National Quality Award.  During that time, he worked with the Director to help develop Healthcare Criteria for the Award. He did similar work for New York and Connecticut with their State Healthcare Quality Awards.

Dr. Couch has advised two National Directors of Health Information Technology (ONC), senior staff at  the Institute of Medicine’s (IOM) Committee on Health IT and Patient Safety, lead officials at the Agency for Healthcare Research and Quality (AHRQ) and the Executive Director of Health Innovations for the Bipartisan Policy Center (BPC) on how to use Health IT to improve the quality, safety and efficiency of care, while minimizing the risks of medicolegal liability (the “Quadruple Aim”).  In October, 2013, “Health Data Management” featured his work in this area.  In 2013, he also got published an “Editors Correspondence” in “JAMA Internal Medicine” on how to accomplish this “Quadruple Aim”.  His most recent book on “Achieving the Quadruple Aim in a Technology-Driven Transformed Health System:  Better Care, Improved Health, Lower Costs and Decreased Medical Liabilty” was published in 2014.

He has taught health policy, healthcare quality, patient safety, medical risk management and computer assisted clinical decision making at Penn’s School of Medicine and Wharton Schools, Johns Hopkins,Cornell, NYU, Harvard, Yale and Oxford Universities (Wolfson and Green Templeton Colleges). He conducted funded methodological research at the Leonard Davis Institute for Health Economics and National Healthcare Management Center at Penn. Since 2010, Penn has awarded each year at Commencement the James B. Couch, M’81 Prize to the Senior Medical Student who has made the greatest academic, professional and scholarly research contributions in the joint fields of Medicine and Business.

Dr. Couch’s education includes a BA from the Social and Behavioral Sciences Honors Program at the Ohio State University; a JD (Doctor of Jurisprudence) from the Indiana University Maurer School of Law; and an MD from the University of Pennsylvania Perelman School of Medicine.


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