|A. Eugene Washington, MD, MSc|
Why do academic health centers (AHCs) exist? This question is addressed in an article I wrote, along with David Geffen School of Medicine at UCLA and UCLA Health System colleagues, that appeared in the Journal of the American Medical Association last November. We believe that these Institutions — approximately 135 of them in the U.S. — exist to ensure sustainable healthcare through their integrated missions of patient care, education and research. Yet, many of these centers operate in ways that threaten their viability. We state that AHCs must reconfigure and transform rapidly if they are to survive.
Why this concern? For too long, AHCs have existed as a cottage industry in a fragmented market, blind to the costs of duplicative infrastructure and paid a premium for claims of quality, without the tools to measure or ensure it. As value-conscious purchasing forces AHCs to compete among themselves and with other health organizations, many will face critical threats. Centers that invested early in integrating care — primary care, information technology and analytics, as well as competing on value — are poised for continued growth. But those that fail to respond effectively to the changing healthcare landscape may find their clinical revenues unable to support education and research and jeopardize their leadership in clinical training.
One of the factors contributing to the precarious state of many AHCs is siloed clinical care that has diminished accessibility and coordination of care for patients and allowed unnecessary duplication of services and comparatively poorer outcomes. Pricing that is higher than comparable services elsewhere is another problem. To some degree this reflects the actual value of care provided for complex conditions. However, it is also related to limited integration of care and unnecessary care.
What can AHCs do? We must adopt more of a patient focus, developing approaches that follow the patient, deploying multidisciplinary teams and integrated practice units across departments. We must become more population-health centric, learning to care for the health of populations while using a global budget to manage the health of a specific population. We must begin leveraging the vast reservoir of health-related big data to help create the most effective means of providing care. We must shift to a value-conscious state of mind, eliminating waste through the consistent use of evidence-based practices and by avoiding unnecessary tests. And AHCs must lead discovery in the prevention of disease and disability, recognizing that prevention is the ultimate value-added measure. As profound change rapidly occurs in U.S. healthcare, the fate of AHCs and our ultimate contribution will be determined by how we respond. Centers pursuing the disruptive transformation we’ve outlined will not only survive but thrive. And these institutions will continue providing value to society, patients and communities.
A. Eugene Washington, MD, MSc
Vice Chancellor, UCLA Health Sciences
Dean, David Geffen School of Medicine at UCLA
Gerald S. Levey, MD, Endowed Chair