With a tripartite mission of education, clinical care and research, academic medical centers (AMCs) have long held a unique role in higher education and health care. AMCs provide critical patient care services that often are unavailable elsewhere in communities, including trauma center, burn center and transplantation services. Furthermore, although they account for only six percent of all acute care hospitals, they train 75 percent of physicians. At the same time, AMCs are a critical component of the national safety net, providing 38 percent of all hospital charity care and approximately 28 percent of all Medicaid hospitalizations.1
In what I call the “new normal” of health care, AMCs face significant special challenges that health systems which don’t have a tripartite mission do not face. These include the rising levels of medical student debt, federal funding cuts to medical research, too few federally-funded residency training slots to address the looming physician shortage, substantial losses from Medicare revenue and cumbersome bureaucracies that, if left unchanged, will leave us further behind competitors who are able to provide the same services, but who will do so more efficiently and at lower cost.
AMCs aren’t going away – we have a critical role in research, education and health care – but, we must change and reinvent ourselves in order to survive and thrive.
We’ve navigated tough times before and we will again. Our focus must remain on innovation and rethinking how we do what we do in order to build a health care system that is more effective, safe, efficient, affordable and accessible. This is why we initiated a UMHS strategic plan in 2009 – to position UMHS to thrive and lead in health care’s “new normal.” Our strategic plan creates a roadmap for strategic action, provides a context for identifying and acting on key areas of opportunity and uses for our resources, and defines metrics by which we can evaluate our performance. Successful execution is enabling us to reach important milestones and achieve important outcomes.
We are engaging in strategic partnerships and affiliations to realize greater clinical efficiencies and better serve Michigan families with care in the right place at the right time. This includes creation of the Acute Care for Elders (ACE) inpatient unit at St. Joseph Mercy Ann Arbor, expanding UMHS inpatient services at Chelsea Community Hospital, agreements with Trinity-Michigan, Integrated Health Associates and MidMichigan Health, and our proposed affiliation with Allegiance Health. Additionally, we are on track to open our new Northville Health Center this year and provide more convenient services along the I-275 corridor.
We are negotiating with insurance payers to ensure appropriate and fair fees for complex services while preparing for how we’d survive in a “Medicare reimbursement rate only” world.
We continue to be a national and statewide leader in demonstration projects and collaborations to evaluate shared savings, patient-centered medical home models and the effectiveness of accountable care organizations, including the Physician Organization of Michigan ACO, which is helping nearly 5,000 physicians serve more than 110,000 Medicare patients in Michigan, the Michigan Primary Care Transformation Project (MiPCT) and partnerships with Blue Cross Blue Shield of Michigan.
We are in the process of changing our Medical School curriculum from one that is largely time based to one that is competency based and allows students to progress at their own pace to finish in three to five years.
A taskforce has been formed to evaluate how we might leverage the skills of physician assistants and advanced nurse practitioners in primary care to enable physicians to focus on those things they are uniquely qualified to do, and improve access and the patient experience.
We created Fast Forward Medical Innovation, which recently was awarded $2.9 million from the Davidson Foundation and last year received $2.4 million from the Michigan Economic Development Corporation to fund the U-M Michigan Translational Research and Commercialization for Life Sciences Program (U-M MTRAC). Increasingly, our Medical School is being recognized as a hub of translational research, innovation and entrepreneurship.
In the past several years we have built an impressive and talented team to lead the UMHS Victors for Michigan campaign. Funding raised via this campaign will be an important factor in offsetting some of the costs associated with research and education – the parts of our mission that depend on investment for long term lifesaving and life-changing returns. We are already 45 percent toward our $1 billion goal!
This is a just snapshot to demonstrate that this isn’t business as usual – we are in an exciting time of change and transformation. AMCs need to rethink our current cost structures and decision making processes. We need to evaluate our medical education and training curricula. And we need to continue to advocate for increased national investment in biomedical research.
I was honored to be a speaker at the MCIT all-staff meeting last week. During my presentation I encouraged attendees to be the people at the forefront of innovation and change. I asked them to be the people who discover and invent new tools and technologies that make health care more efficient, accessible, affordable and reflective of patient and family centered care philosophies. I ask the same of all of you. The key word in our vision to create the future of health care is “create.” If you really want to make a difference in the way you approach your work or impact the world, look at your work and the world in a new way – see something unique and find a better way to do it. This is our challenge and our charge. This will define the next generation of leaders and best in medicine.
1. Association of American Medical Colleges