Monday, February 24, 2014

Victor J. Dzau:  A Transformer of American Medicine

Think globally, act locally.

Strategic Concept

The health care landscape is rapidly changing owing to the Affordable Care Act, state budget deficits, and private insurers responds to constrain cost growth.

Victor J. Dzau, MD, and seven co-authors, Duke University School of Medicine and Duke University Health System,  “Transforming Academic Health Centers for an Uncertain Future,” New England Journal of Medicine,  September 12, 2013

Victor Dzau, MD  is a remarkable man.    In his 10 years as head of the Duke University Health System,   he has transformed Duke from an excellent regional medical school into a world leader with  multiple spheres of influence.   After ten years at Duke a chancellor for health affairs and CEO of its health system,  he is leaving to become president of the Institute of Medicine,  the most prestigious position in American academic medicine.  He will serve in that position for a 6 year term.  

His  mission will be to transform academic health centers to meet the demands  of an uncertain global and domestic  future.

Dzau  has long  recognized  the profound effect of global medicine and has positioned Duke as world medical leader. Dr. Dzau has made significant impacts on healthcare through his leadership in translational research, health innovation, global healthcare strategy and delivery. 

Under his leadership, Duke has established Duke Translational Medicine Institute, Duke Global Health Institute, Duke-NUS Medical School in Singapore and Duke Institute of Health Innovation.

As one of the world’s most preeminent academic health leaders, Dr. Dzau advises governments, businesses and universities worldwide, serving on advisory councils and boards of directors. He is a Council member of the Institute of Medicine (IOM) of the National Academy of Science USA, a member of the Board of Directors of Singapore Health System, former member of the Advisory Board of Canadian Institute for Health Research, former member of the Advisory Council to Director of National Institute of Health (NIH), chair of the NIH Cardiovascular Disease Advisory Committee and past chair of the Association of Academic Health Centers.

In 2011, he led a partnership among Duke Medicine, World Economic Forum and McKinsey & Company to establish the International Partnership for Innovative Healthcare Delivery, and chairs its Board of Directors.

But while active in world medical circles,  he has been cognizant of  how health reform, particularly the Affordable Care Act, is transforming medicine in America. 

In academia,  it is no longer be enough to serve your local and regional communities or to have a cluster of world class specialty centers.  It is no longer  enough to attract National Institute of Health and other grants. It is no longer  enough  to have  a series of independent specialized fiefdoms connected by a common heating system,  a commodious parking lot,  and buildings held together by a prestigious academic name.   It is no longer enough “Publish or perish.” 

Now,  AHS faculty members  must“transform or perish.”

According to Dzau et al, in a September 13 article in the New England Journal of Medicine  the following factors have brought about this new state of academic affairs: 

·         ObamaCare regulations

·         Reductions in Medicare and Medicaid reimbursement

·         The driving of health  plan enrollees to lower cost providers into  narrow  tiered networks of  physicians and hospitals

·          Ending of government funding for hospitals treating low income patients.

The result is that academic centers are falling 30 to 40 cent short for every federal dollar needed to support their research and educational missions.

How to respond?

Dzau  and his co-autors  recommend   these survival  strategies.

·         Balance specialized clinic excellence with population health. 

·         Combine “centers of excellence” with research translating that excellence into training for doctors.

·         Become high-performing regional health systems ”spanning the spectrum from community-based and primary care to highly specialized hospital and post-acute care, all linked by effective information systems.’\

·         Increase research yields by translating results so they have an immediate impact on practices and services offering natural economies of scale and fostering innovation and entrepreneurship.  

·          Offering new ways to engage patients, through e-healthy, mobile devices, and increased personalization driven by advanced data analytics.

·         Require  centralized enterprise-wide planning and management to prepare for an uncertain future. 

·          Centralize coordination and tamp down  with faculty individuality and autonomy will not be enough to get the job done.  

Challenging Sacred Cows

AHCs, in the words of the authors, must “reexamine their approaches, challenge sacred cows, and prepare for transformation.  While doing these things, academic centers must realize that the bulk of revenues come from mundane operations and common illnesses, not from high tech procedures or from treating rare diseases.  

University health centers must come to grips with the new realities that catering and integrating the outside environment with what goes on inside is a key to survival in the brave new world of health reform. AHCs must restructure  to deliver a systematic, organized, and purposeful level of services to patients and referring physicians.

Tweet:  Academic health centers face uncertainties because of health reform, lower payments , and shifts of patients to lower-cost environments.

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