AAMC Reporter: July 2009
A Word from the President: "Academic Medicine — Leading the Way
Through the Reform Debate to Better Health Care"
Since becoming AAMC president three years ago, I continually have
been impressed by our members' innovative spirit and willingness
to move toward a new health care culture—one that is more patient-centered
and quality-focused. In fact, the rate of innovation among our institutions
often outpaces our ability to document, much less publicize, the
degree of transformation underway. However, I also have seen our
constituents' frustration, both at not having the tools they need
to move forward faster and at the many systemic constraints they
have faced.
Today, with major health care reform legislation moving through
Congress, the nation may be on the verge of eliminating some of
these impediments (for example, the lack of health care insurance)
that have hampered innovation on a wider scale. And while this news
is encouraging, it must be tempered with the realization that comprehensive
reform of care delivery will not occur overnight. Despite the best
efforts of the many parties committed to meaningful change, no single
piece of legislation will take us to that much better system we
all visualize. In the face of all the current system's obstacles,
the question is how to maintain momentum and drive the nation toward
transformational health care change.
In discussing this question with our members, I have become even
more convinced that academic medicine has a critical and singular
role to play. By capitalizing upon our innovative spirit and collective
energy to improve the nation's health, I believe we can develop
regional alliances to test new delivery models that may very well
catalyze change nationwide. The concept we have developed and proposed
both to Congress and the White House to describe these federally
supported alliances is the "health care innovation zone" (HIZ).
The underlying premise of an HIZ reflects what many stakeholders
and policymakers have come to realize—that better integration among
providers is a keystone of successful reform. In other words, we
must do a better job of aligning providers and their incentives
and improving synergies among the various components of our health
care system, including the full spectrum of insurance coverage,
care delivery, financing, and information systems. While many interesting
models (e.g., accountable care payment methods and medical homes)
have been articulated, there is a knowledge gap between conceptualizing
these tools and actually creating a wellfunctioning system.
In the HIZ, an academic medical center would take advantage of
its existing alignment of hospitals and physicians and serve at
the nexus of an integrated delivery network that partners with others
to jointly encompass the full spectrum of comprehensive and community
care. Working together with government and other stakeholders, and
freed of the current reimbursement disincentives and regulatory
constraints, these regional alliances would be able to further explore
and test new business models of delivery and other innovations.
On a limited basis, the HIZ concept is already at work in a few
areas where institutions are able to leverage health care spending
for large populations. These institutions are able to do so in large
part because they are highly integrated and also benefit from geographic
and demographic factors that enable them to overcome the reimbursement
system's counterproductive incentives. Given these advantages, these
institutions have been able to achieve a high level of innovation
that makes them stand out as leaders in an otherwise dysfunctional
health care system.
In the absence of a more immediate and comprehensive transformation
of the health care system nationwide, creating a variety of health
care innovation zones will help us test the effectiveness and feasibility
of various models, discovering which are generalizable to other
parts of the country. In turn, this testing will spur innovation
on an even larger scale and help us develop the necessary tools
to lead our nation forward. Among these tools are: removal of the
barrier posed by a financing and delivery system that prevents interdependent
care components from relating efficiently and effectively; relief
from antitrust laws that prohibit provider discussion about integration
and joint financial management; and investment in information technology
and research that allows us to measure core functions of coordination-of-care
and permits development of an evidence base for how new models are
best implemented.
More importantly, implementation of the HIZ concept would help
test the validity of what constitutes a fundamental disruption in
the business model of health care—from paying for units of service
to paying for outcomes. In this sense, the HIZ will present key
learning opportunities for all of us, teaching us what works and
what does not, and the possible unintended consequences of these
changes.
I cannot emphasize more strongly how success in this effort depends
on recognizing our collective potential—as medical educators, researchers,
and clinicians— to bring about transformational change. No other
community possesses the breadth and depth of clinical expertise,
longstanding track record of caring for all population segments,
and built-in health services research capacity to collect and analyze
the valuable data that would be produced in an HIZ. Further, our
ongoing work to train health professionals at all levels would become
more focused on preparing new providers for care delivery that is
patient-centered and for work environments that are increasingly
interprofessional and team-centered.
There is no question that health care reform will challenge us
in new ways, and there will be lessons to learn. What is being openly
discussed in the health care reform debate represents a sea change
in the way most of us have experienced, provided, and taught health
care. I cannot think of a better time for academic medicine to step
forward and lead the nation toward the health care system we all
visualize and deeply desire. I am eager to hear your reactions to
and thoughts about the HIZ concept, and hope that you will share
them with me at AAMCLeads@aamc.org.
Darrell G. Kirch, M.D., AAMC President and CEO
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