It was the Polish astronomer Copernicus who showed that the earth
wasn’t the center of the universe. A similar revolution in thinking
is underway in academic medicine. The ivory tower is no more. The
same applies to our traditional “hub and spoke” model. The hospital is
no longer the center of our universe. It is really the patient who is at the
center. We now have a group of delivery systems that rotate around the
patient, and that whole group needs to be seamless and integrated.
We are in an era of a dynamic healthcare landscape. As we look at health
delivery, health insurance, and health outcomes, they are changing at
historic speed. At the same time, as an academic medical center we have
an inherent wealth of knowledge, especially in our missions of education
and research. Another way to think about this is that academic medical
centers have unique brands. Effectively leveraging our brand and utilizing
the talents that we have will help us succeed in this era of transformation.
As we work to meet the Triple Aim, integrating systems and processes
that help us create value is absolutely critical. Through such integration,
we can decrease our costs, improve our quality, and deliver on our value
proposition. In that regard, academic medical centers are integrated
in key ways that bolster our overall strength. In employing our own
workforce, we have more control over quality metrics, how we manage
utilization, and how we get people to adhere to best practice in clinical
care pathways. Such integration helps us achieve our value proposition
and should be an area of focus.
As we become integrated organizations and work to improve quality and
lower costs, we also need to think about how our people work together.
One of our central challenges today is changing our culture to make
it more interprofessional, patient-centric, and focused on population
management. Specifically, we need to think about how we can work
effectively in interprofessional teams that leverage the knowledge that
each individual brings to the table. Integrating an interprofessional team
approach into our culture may be one of our biggest challenges.
Population health management also mandates that we change our culture
and move from fee-for-service to a population health management
approach. As we move to population health, and as markets become more
competitive, we can no longer remain in our ivory towers. We have to go
where the patients are and work with them in multiple locations, facilities,
and settings.
We need to be creative in establishing partnerships, including
collaborating with organizations with which we may not have partnered
traditionally. At the University of Rochester, we are partnering in new
ways with a hospital some 90 miles away. One of their neurosurgeons
actually drives here every two weeks to treat some of his more difficult
patients with our faculty members—he learns from them, and they learn
from him.
Many academic medical centers are going beyond the word “center”
altogether. For example, we recently unveiled a new brand, UR Medicine,
which refers to all the clinical sites affiliated with the University of
Rochester, including hospitals, labs, physician practices, nursing homes,
and outpatient treatment centers. This change reflects what I believe is
an evolution in ways that academic medical centers and systems now view
themselves.
Bradford C. Berk,
MD, PhD
Former Senior Vice President
for Health Sciences
Former Chief Executive
Officer,
Medical Center and
Strong Health System
Director,
Rochester
Neurorestorative Institute
University of Rochester