Charles M. Jacobs, AB,’53, JD’56, a founding member of the Compass Players improvisational troupe who went on to invent a quality-control methodology that made evidence-based health care widely available, died Oct. 25 in Boston. He was 77 and a resident of Brookline, Mass.
Born Charles David Jacobs on May 28, 1933, in Brooklyn, N.Y., he acquired the middle initial “M” through a process now obscure to family members, but it stuck.
Jacobs won a scholarship to the University of Chicago at the age of 16. This launched a lifetime of innovation, punctuated by spectacular failures and equally spectacular successes. According to Jacobs, “the University of Chicago saw something in me that no one else saw — they bet on this unknown kid.”
Jacobs’ curiosity and willingness to explore all possibilities — “put everything down on a whiteboard” he would say, “don’t say ‘no’ to anything” — resulted in an eclectic career. As an undergraduate, he worked with Paul Sills and David Shepherd to form the “Tonight at 8:30” repertory company. He was one of the initiators of Compass Players, the country’s first improvisational theater and the predecessor of Second City.
Although trained as a lawyer rather than a doctor, Jacobs was among the first to realize in the 1970s that health care quality and efficiency could be improved by using evidence-based clinical data to evaluate the appropriateness of medical care and the effectiveness of treatment. By analyzing data at the individual patient level and then aggregating the treatment results for thousands of patients, his approach established expectations for the best achievable care.
As associate director of the Joint Commission on Accreditation of Hospitals from 1970-75, Jacobs established its Quality Review Center and was principal author of Measuring the Quality of Patient Care: The Rationale for Outcome Audit (1976). In 1976, Jacobs founded InterQual (now owned by McKesson Robbins) to implement the concept of evidenced-based health care. The InterQual system is now used in the majority of U.S. hospitals, as well as government agencies and private health care plans, to evaluate the level of services required by each patient.
“Today we hear and see countless reports about how health care and payment reforms will create the higher-value U.S. health care system we desperately need. Jacobs saw how all this would come together long before others even grasped the potential,” said Stuart Rosenberg, president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Hospital, on whose board Jacobs served as an outside director.
Jacobs was a tireless teacher and advocate of improving the performance of doctors and hospitals so patients could receive the best care. The real measure of his impact is the clarity of his understanding as to the changes it would take to make the U.S. health care system work most effectively.
In a 1987 interview in the AMA’s American Medical News, Jacobs answered a question about how health care quality measurements would evolve over the next decade by predicting: “Payers will be moving toward adopting reimbursement systems that provide financial incentives for high quality, and that will require severity adjustors. The competitive marketplace will reward the qualitative, efficient provider, and penalize the extravagant non-qualitative provider and essentially drive him out of business.”
“He is, of course, being proven correct on all fronts, only his dates were a bit off,” Rosenberg noted. “It has taken the system more than 20 years to catch up with implementing, even partially, the reforms he so clearly understood had to happen back in 1987.”
Jacobs was listed in Makers & Shakers of America’s Health Policy by Medicine & Health (1985). He received a founder’s award from the American College of Utilization Review Physicians in 1986 for “outstanding contributions to the issues of the Quality of Health Care.” In 1988, the AMA’s American Medical News named him its man of the year. In 1998 he was made an honorary life member of the American College of Medical Quality.
Jacobs’ last creative project was to inspire and help produce Madame White Snake, an opera based on a 1,000-year-old Chinese legend. The opera was a birthday gift from his wife Cerise Lim Jacobs, who wrote the libretto. It started as a song cycle, but Jacobs saw the potential for something much bigger. Soon, the 10-minute piece that was to have been performed in his living room for a small group of friends became a full-length opera commissioned by Opera Boston and the Beijing Music Festival. Acclaimed American Chinese composer Zhou Long composed the music.
Directed by Robert Woodruff, Madame White Snake had its world premiere in Boston in February 2010. It became the highest-grossing production in the history of Opera Boston.
“Charles’ creative vision, strategic thinking, laser focus, and tireless optimism were central to the project’s success,” said Carole Charnow, former general director of Opera Boston and now president and CEO of Boston Children’s Museum.
The opera had its Asia premiere in Beijing on Oct. 27, and the performance was dedicated to Jacobs.
“New opera is the most complex art form to create today,” Cerise Jacobs said. “Charles was a man who believed that it is possible for individuals to create beauty in this world and this is the artistic part of his legacy.”
In addition to Cerise, Jacobs is survived by his brother, Frank; his children, Emily MacKean, Jessica Jacobs and Pirate Epstein; and grandson, Dashiel Jacobs MacKean.
—Prof. Jacqueline Stewart
