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

New President / Exciting New Era

Today, the Board of Regents announced the appointment of Dr. Mark Schlissel, current provost of Brown University, as the next president of the University of Michigan. This is wonderful news for the University and for our Health System. Dr. Schlissel is a remarkable physician-scientist who will bring to the presidency an important depth of understanding about academic medicine and biomedical science. We are extremely fortunate that he will be at the helm as we begin an exciting new era at Michigan.

At the same time, we are privileged to have been led by Mary Sue Coleman, a president with great vision and who has moved the university to unprecedented levels of accomplishment. Given the track record of our president-elect, we can expect to continue this extraordinary trajectory of leadership. This bodes well for the future of the entire university and specifically for our Health System. It is a moment of grand celebration for us and all of our friends and supporters.

Read the University’s announcement here.

GO BLUE!

Honoring the Values of Dr. Martin Luther King, Jr.

mlkquote_smallToday, once again, we have an opportunity to honor Dr. Martin Luther King, Jr.. This is a day to remember and celebrate the values that he demonstrated during his remarkable life — values like compassion, commitment, moral compass and service to others. These are values that drive our Health System and define our mission. We must never relent in our work to promote diversity and equity in all that we do, from the care we provide to the people we employ. We must continue to address disparities, fight injustice and challenge complacency in societal norms.

How will you honor Dr. King and these values today, tomorrow and beyond?

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!

Thank you, Rich & Susan Rogel

UDE, Elizabeth Lange

Susan & Rich Rogel

Today, the University announced an incredible gift from an extraordinary couple – Rich and Susan Rogel. Rich and Susan have given the University $50 million — $30 million for medical school scholarships, $10 million for the U-M Center for Chinese Studies and $10 million for future U-M initiatives.

I cannot adequately express my gratitude for the Rogels’ amazing demonstration of support for our University, our Health System and our mission to serve others and cultivate future generations of leaders and best. At the same time, I am not surprised that Rich and Susan would make such a gift. No matter what might be happening in their own lives, they are always looking for ways to help others and make the world a better place. They’ve done this by funding scholarships in the Ross School of Business, the School of Social Work, and the School of Music, Theatre & Dance, in addition to the Medical School.  They partnered with us to create the Max Rogel Research Fellowship in Pancreatic Cancer and the Allen H. Blondy Research Fellowship for Melanoma. And most recently, when they experienced the painful and tragic loss of Susan’s daughter last year, they honored her by establishing the Ilene Ross Joseph Memorial Fund in Personalized Medicine.

In addition to generous gifts of dollars, Rich has given us an even more valuable gift over the years by volunteering his time, energy and vision in a number of advisory roles. I have been privileged to work closely with Rich in his role as a longstanding member of the Health System Advisory Group, which is a small group of external volunteers who are very dedicated to Michigan and to our Health System, and provide strategic counsel and input on a variety of matters relevant to our tripartite mission.

ohp-rr-china-may-2012_edited

Left to Right: Professor Qiudan Sun, Director of the Office of International Cooperation at Peking University Health Science Center; Ora Pescovitz; Rich Rogel; Professor Xian Wang, Vice-president of Peking University Health Science Center.

Then, last May, I had the unique privilege of spending time in China with Rich and experiencing the country through his eyes. A true citizen of the world, Rich has been a wonderful supporter of our Health System’s and University’s important collaborations with universities in China, even to the point of establishing the Richard Rogel China Research and Travel Endowment fund in the College of Literature, Science and the Arts. Rich believes in the amazing possibilities that can emerge through global entrepreneurship, medical innovation and scholarship opportunities for University of Michigan faculty and students. Of memorable note, while we were in China Rich also introduced me to some of the spiciest food I have ever eaten. In addition to a heart of gold, that man has a mouth of steel!

And now, once again, Rich honors us with his time, energy and vision by agreeing to serve as chair of the Health System component of the Victors for Michigan Campaign. I cannot think of a more gifted, inspiring, dedicated and articulate person to lead our Health System campaign and serve as our champion.

Rich is a brilliant and adept businessman and entrepreneur, who believes in using his own success to enable that of others. He is a man who embraces new and different ideas and perspectives, and creates opportunities for others to do so, as well.  He is someone I consider a great friend and role model, who has encouraged me to grow and be a better leader and person. And he is true Blue.

Thank you Rich, and thank you Susan. We are so fortunate to have you as our Victors.