My Role as EVPMA

As my five-year appointment as the University of Michigan’s executive vice president for Medical Affairs nears conclusion, I have been thinking about my future – both professionally and personally. Being EVPMA at the University of Michigan and CEO of the University of Michigan Health System has been an enormous privilege. I have relished my time here and will forever be grateful for the growth, experiences and relationships made possible by this opportunity. UMHS is a community of extraordinary people who do extraordinary work. I have been honored to lead this organization, which is what made this decision very difficult for me. I have decided to not serve a second five-year appointment. My last day as EVPMA will be June 1, 2014.

Over the last five years, UMHS has grown and changed tremendously – not just in size, but in strength. I know that I will be leaving the health system well positioned for the future. We should all be incredibly proud of the work we have done together, including creating a strategic plan to guide us now and into the future, and dramatically changing the way we do business –“here” no longer means only Ann Arbor. We have and will continue to expand our reach and demonstrate our core commitment to the health of individuals and families throughout the state via new and enhanced relationships with other hospitals, health systems and physician groups.

Additional points of great pride that make us the envy of others include:

  • Our continuous efforts to create the ideal patient care experience, which have resulted in our highest-ever patient satisfaction scores.
  • We are financially sound and have been excellent fiscal stewards of our resources. We must continue to be vigilant to use our resources carefully, but, with over $3 billion in cash, we are able to invest strategically in all components of the tripartite mission of clinical care, education and research.
  • We lead the state and the nation in population management, as well as physician and hospital collaborations to improve quality and safety. These efforts have had major cost savings for us and governmental and third-party payers.
  • We are home to a medical school that remains in the top tier of academic medical centers for a remarkable student population, outstanding research productivity, excellent primary care and specialty programs, and the desirability of its graduates for selection by residency program directors.
  • We have built an infrastructure to enable us to envision and launch the Victors for Michigan campaign – and raise 45 percent of our $1 billion goal to date and before public launch.
  • We are leveraging the vast promise of the NCRC to exceed expectations, facilitate interdisciplinary collaboration, support entrepreneurship and enable unprecedented opportunities for scientific discovery, and investigator recruitment and retention.
  • We have made diversity, health equity and inclusion high-level priorities for our organization.

Because of the foundation we have laid, we have great momentum moving forward. UMHS will build upon its successes and continue to be one of the leading Academic Medical Centers in the country; of this I am confident.

Thank you for making this past five years a time that I will always cherish. I look forward to your continued excellence in creating the future of health care.

Ora

In Pursuit of Health Equity & Inclusion

Imagine the fear of experiencing a medical emergency in a hospital where nobody looks like you, speaks your language or knows your culture.

Imagine the frustration of having to choose between going to the doctor and buying groceries.

Imagine the distress of being a parent who isn’t permitted to make care decisions for your child because your state doesn’t recognize your marriage and your partner is the legal parent via biology or adoption.

When we incorporated diversity and cultural competency into our Health System strategic goals and launched the UMHS Office for Health Equity and Inclusion, we did so with the hope that one day these scenarios and the many others that plague underserved and underrepresented populations will no longer exist. The future of health care that we strive to create is one in which all patients have access to appropriate and timely care in a respectful and compassionate environment.

Real change comes from first understanding the problem and the underlying causes and then acting on that knowledge to alter behaviors and practices to improve individual and community outcomes. This is the “sweet spot” of an academic learning health system; this is where the intersection of our tripartite mission of education, research and clinical care can do the most good for the most people. While there is a lot of work to do in pursuit of our desired future state, we have made impactful progress toward this goal at UMHS.

For example, we have several outreach clinics throughout Michigan that focus on the needs of underrepresented and underserved patient populations, including the U-M Migrant Farm Worker Outreach Clinic in Lenawee County, Ypsilanti’s Corner Health Center for people ages 12-21, the Delonis Clinic for homeless individuals and families in Washtenaw County and the Student Run Free Clinic in Pinckney.

Since 1994, the Japanese Family Health Program run out of Family Medicine at Domino’s Farms has been implementing innovative programs that transcend cultural barriers and impact all components of our tripartite mission. Popular patient and family-centered features of the program include monthly birth center tours with a Japanese-speaking guide, prenatal group classes for mothers and fathers and an extensive library of Japanese and bilingual health education materials. Program faculty have posted medical education materials on Open.Michigan, an open source community created by the University to enable global sharing of  educational resources and research, and in 2010, the program was awarded a $1.4 million grant from the Japanese government to establish a residency training program and help Japanese doctors improve in-country family medicine practices.

Then there is the work of 31 active patient and family advisory councils throughout the Health System. These are groups of patients, family members, faculty and staff who are working together to identify and implement ways to make our practices, policies and environment more inclusive. In the future, we want to engage more individuals from vulnerable populations in the councils to better understand their unique challenges related to access, services, resources, transportation and more. Additionally, we want to expand these efforts into the ambulatory care setting and work with volunteer advisors to find ways to improve representation of diverse individuals in clinical trials. To address the latter, we are providing advisors with opportunities to participate in Patient Centered Outcomes Research by collaborating with UM investigators on the development and design of research proposals. At the same time, we are partnering with Nursing, Public Health and other disciplines which conduct community behavior research.

This is just a snapshot of initiatives under way at UMHS to address access, inclusion and equity. Certainly, there is much more to do if we are going to affect real and lasting change in our health care system.

Next month, each of you will have the opportunity to participate in a campaign led by the Office for Health Equity & Inclusion. OHEI was established to advance our health system’s equity and inclusion goals. With Dr. Carmen R. Green as the inaugural Associate Vice President and Associate Dean for Health Equity and Inclusion, I know that we will make impressive and substantial progress. Our voice as a Health System must reflect the diverse voices of the patients we serve, the health professionals we train and the people who work here. The Talk Health Care Equity campaign will be your chance to add your voice to this important conversation, and I hope that each of you will take advantage of this opportunity.

No matter who a person loves, where s/he lives, what s/he believes, how young or old s/he is or what s/he looks like, all citizens deserve access to the right care in the right place at the right time in an environment that is inclusive and welcoming. In a country as wealthy and democratic as the United States, exceptional health care should not be a luxury. It should be a right. Let’s work together to change the status quo.

Succeeding in Health Care’s “New Normal”

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

At UMHS, the Season of Giving Lasts 365 Days a Year

Once again, it’s the ‘season of giving.’ Medical students recently hit the cold and snowy streets of Ann Arbor to collect donations during Galen’s Tag Days 2013. Members of the Detroit Red Wings decked our halls to bring smiles to patients’ (and employees’) faces. And people don festive holiday ties, sweaters and socks to bring a little bit of joy into an ordinary day. Each December, I am energized by the spirit of cheer and generosity that is amplified this time of year.

I’ve written before on the topic of giving back as a way to make the world a better place. At UMHS, we don’t have to look beyond our own walls to witness and experience many inspiring examples of people of all ages and abilities giving back in meaningful ways.

Consider musician-composer Paul Skripnik who, at the age of 29, put on a patient gown and prepared to undergo an operation surgery that he hoped would alleviate him of the daily threat of seizures and allow him to do what he loves most – write and play music. For Paul, living with epilepsy meant living with a troublesome burden that left him afraid to walk on the sidewalk, cross the street or drive. He longed for treatment that would give him hope and health, and he found both as a patient in the UMHS Comprehensive Epilepsy Program. After a series of tests and consultations, the epilepsy care team led by Drs. Simon Glynn and Oren Sagher determined a treatment plan for Paul. In September 2011, he underwent a successful brain surgery that eliminated his seizures. This year, Paul celebrated a year and a half of seizure-free living with a concert featuring his original compositions. Additionally, in October, he performed and participated in a lecture as part of U-M’s Investing in Ability Week. Paul has turned his challenging experience into an opportunity to give back by increasing awareness and generating support for others living with epilepsy.

Then, there are wonderful people like Pat and Frank Ducato. Seven years ago, Frank experienced life-saving care at UMHS. In 2009, the couple decided to give back as volunteers in the Comprehensive Cancer Center. One afternoon each week, Pat provides assistance as a greeter at the CCC main lobby courtesy desk, while Frank helps patients and visitors access important cancer information as a volunteer in the Patient Education Resource Center. When interviewed for a story published last fall, Frank recalled giving some coloring books and cancer literature to the children of a mom undergoing breast cancer treatment. He remembered the husband coming up to him during the family’s next visit to thank him and say that after the children read the literature, they treated their mother differently. In Frank’s own words, he conveys the power of giving: “You get so much from being able to help somebody like that.”

And, finally, I was recently reminded of the extraordinary and generous act of a very special fourth-grader named Maya. A few years ago, when annual giving officer Kathy Valley opened one of many holiday cards, she found three one-dollar bills and the following message: “Here is the last of my Christmas money. Please use it to take care of people with cancer, from Maya.”

Generosity comes in all types and sizes. Whether it is $3, three hours of volunteer service, three handmade quilts or three months of participation in a clinical trial, every act of giving contributes to our greater mission to help and heal.

Charles Dickens, author of the classic holiday novella A Christmas Carol, once said “No one is useless in this world who lightens the burdens of another.”

This might be the time of year when society most publicly encourages and displays the spirit of generosity, but here at the University of Michigan Health System, the season of giving lasts 365 days a year. This is a place where generosity and compassion drive the important work we do each and every day, and we couldn’t do what we do as well as we do it without our exceptional faculty, staff, students, volunteers, philanthropists, advocates, friends and supporters.

Enjoy “Never Doubt,” a slideshow that celebrates giving at UMHS, and feel free to share your experiences with generosity in the comments section below.

Thanks for all that you do!

Happy holidays!

Reasons To Be Thankful

This week, many of us will celebrate Thanksgiving and take time to appreciate those things for which we are fortunate and grateful. As a Health System and as a community united by a commitment to improving health and saving lives, we have many reasons to be thankful. I’d like to share just a few of them with you in this post.

Graph 10 years_SmallThis year, we performed our 2000th liver transplant and our 200th transcatheter aortic valve replacement, and we delivered our first set of quintuplets. We celebrated the Department of Radiology’s centennial, as well as Gifts of Arts’ silver anniversary. And because of ongoing continuous improvement initiatives, patient satisfaction is at an all-time high. We are on target to achieve a satisfaction index score of 93 by Fiscal Year 2017, which is the goal defined in our strategic plan. I will be surprised if we haven’t exceeded our target by that time!

Research coming out of our Medical School resulted in a record 133 new inventions and 41 patents, representing one-third of the University’s total output. In addition, we produced significant discoveries across the spectrum of disease and care delivery, including adding disease-specific stem cell lines to the national registry, coordinating a global DNA study that identified new drug targets and a bigger role for triglycerides in heart risk, demonstrating a cellular difference in the body clocks of people with depression, and discovering that commonly used catheters actually double the risk of blood clots in ICU and cancer patients.

The excellence of our Medical School training and students was honored with an incredible gift of $30 million in scholarship support from Rich and Susan Rogel. At the same time, the compassion of our Medical School family was powerfully evident in how you supported one another after Paul DeWolf’s tragic death, and in rebuilding the Student Run Free Clinic after it burned down in February.

Thanks to the voices of many individuals and groups within and outside our community, Michigan Medicaid expansion was passed and 400,000 Michiganders now qualify for health insurance. Additionally, we continue to be prominent in advancing the dialogue around health care reform, the Affordable Care Act, research funding and more.

And, thanks to extraordinary efforts of faculty and staff across the entire Health System, we have been operating at roughly a 3 percent margin for the last 10 months. This is a terrific place to be, given the challenges we’re facing. We want to continue on this trajectory, heading toward a goal of a 5 percent margin by 2017.

I know that each of us is grateful for the opportunity to play a role in creating the future of health care, and I am thankful for our incredible staff, faculty, students, trainees and volunteers. There can be no greater privilege than to work with you in this extraordinary organization.

This week, please remember to take time to say ‘thank you’ to those who help you do what you do, because we never do it alone.

Happy Thanksgiving!

The Government Shutdown, Sequestration & The Future of Medical Research

As you know, these are concerning times. It’s hard to comprehend that the government of the United States of America has been closed for business for nearly a week now. Recently, I had occasion to meet with colleagues in three different settings to discuss common and pressing concerns. The day before the shutdown, I met with the advisory board to the director of the Clinical Center at the NIH. A few days earlier, I met with the board of the Association of Academic Health Centers and before that with a collective of CEOs of major health-related organizations. All of us are deeply concerned about what awaits with respect to federal funding for research, the Affordable Care Act, Health Care Exchanges and more. I imagine these topics are top of mind for you, as well.

Notably, at present, our Health System is in an enviable position, given that most of my colleagues said that their hospitals are seeing a drop in census to 60 percent or less, as well as decreasing revenue. We, on the other hand, grapple with challenges of high demand and have markedly recovered from the financial challenges of last year. This isn’t by happenstance or luck. Our high census is because of our excellent reputation and the outstanding care we provide. And our current financial stability is because of your deliberate and conscientious efforts to see more patients, control resources and improve workflow – all while improving patient satisfaction scores to their highest levels ever. We should take great pride in this, but, at the same time, we must continue to be diligent and focused as we navigate ongoing challenges, such as the current government shutdown and sequestration.

promoimageThis weekend, I shared our concerns in the Detroit Free Press about the $1.5 billion cut to National Institute of Health funding because of sequestration, along with the shutdown (Article). We continue to monitor the impact on our Health System now and in the long term. While current grants have been safe, researchers preparing to submit applications for new grants — including a large number who expected to submit applications in time for a major October 5 deadline – are on hold until the shutdown ends. This may lead to delays in obtaining funding and starting research. Clinical trials already under way at UMHS are continuing, though there may be some slowing in cases where federal agencies process experimental drugs. Some research funded by federal contracts has stopped or may need to, including that of a seven-person team analyzing data from the 2009 pandemic H1N1 flu outbreak for the Centers for Disease Control and Prevention. This group has been told to cease all activities on this project when flu season is right around the corner.

But even without these new threats, it has already been difficult for scientists to get crucial funding for new discoveries. In fiscal year 2013, despite overall growth in federal research funding, NIH funding to U-M fell 1.8 percent. That represents a $9.6 million cut, a significant reduction for those hoping to discover new cures and treatments.

This is a problematic trend. NIH is by far the university’s largest research sponsor, amounting to $509.7 million last year, or more than 38 percent of the total research budget at U-M. And it’s the research conducted on campuses like ours that develops the people and ideas that drive the creation of new products and services, new companies and new industries.

With research funding at risk, research itself is at risk, as is our standing as a global leader in medical innovation. While the rest of the world increases spending for crucial biomedical research — spending is up 20 percent in China and India and 10 percent in Japan and Brazil — U. S. funding has dropped 5 percent. We are falling behind in research spending, and the impact is potentially devastating for our nation’s physical and economic health.

It’s important to note that medical research is a major economic driver, too. The U.S. government invested $3.8 billion in the Human Genome Project and achieved an estimated return on investment of $141 for every dollar spent. That work laid the foundation for significant advances in molecular medicine, energy, bioarchaeology, DNA forensics and even agriculture. According to Robert Wood Johnson Foundation studies, preventing just 5 percent of new cases of chronic conditions would reduce Medicare and Medicaid spending by nearly $5.5 billion each year by 2030. The Information Technology & Innovation Foundation estimates that the impact of sequestration on research will be a loss of up to $200 billion in our GDP over several years.

When we stop investing in research, we’re saying that we as a nation are no longer committed to leading the world in discovery and being on the cutting edge of medical science. We’re saying that we are okay with the fact that our nation — a nation built on pioneering innovation — will no longer be in the lead. We’re saying that we are comfortable becoming increasingly reliant on other nations to develop and produce new drugs, therapies and treatments, even if those nations have different and potentially less stringent regulatory requirements. We’re saying that we are okay with discouraging some of our most prolific and innovative minds from pursuing careers in science and biomedical research because we have decided against funding this work.

Science moves the world forward and medical research offers limitless potential to improve lives and communities. Academic health centers and research institutions like ours are where life-changing science happens. Like you, I take immense pride in being part of the University of Michigan Health System because it means being part of a passionate commitment to making the world a better place, one discovery, one encounter, one family and one patient at a time.