Victor J. Dzau: A Transformer of American Medicine
Think globally, act locally.
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.
mission will be to transform academic health centers to meet the
demands of an uncertain global and
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
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
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.”
AHS faculty members must“transform
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:
in Medicare and Medicaid reimbursement
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?
and his co-autors recommend these survival strategies.
specialized clinic excellence with population health.
“centers of excellence” with research translating that excellence into training
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.’\
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.
health centers face uncertainties because of health reform, lower payments ,
and shifts of patients to lower-cost environments.
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