Divisions of General Pediatrics and General Internal Medicine, & Gerald R. Ford School of Public Policy, University of Michigan
Clinical Implications of Healthcare Reform for Academic Medical Centers Matthew M. Davis, MD, MAPP Professor – University of Michigan AAIM October 2013 New Orleans, LA
Inspired by the mission, Squeezed by the market
Academic medical centers
Inspired by the mission, Squeezed by the market
Academic medical centers
Clinical care
Service
Education
Research
Inspired by the mission, Squeezed by the market
Academic medical centers Research Service
Clinical care
Service
Clinical care Education
Challenges to AMC Clinical Activities • Location, location, location
• Distractions
• Competition
Challenges to AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Concentrated adverse payer mix • Limited opportunities for growth in physical plant
• Distractions
• Competition
Challenges to AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Concentrated adverse payer mix • Limited opportunities for growth in physical plant
• Distractions – By other worthy aspects of AMC mission • Teaching balanced with efficiency • Research balanced with throughput
• Competition
Challenges to AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Concentrated adverse payer mix • Limited opportunities for growth in physical plant
• Distractions – By other worthy aspects of AMC mission • Teaching balanced with efficiency • Research balanced with throughput
• Competition – With other providers in local markets • Less nimble, slower to adapt • Less access to capital
Key challenge to AMCs: Clinical Relevance
Key challenge to AMCs: Clinical Relevance
1961 … Out of every 1000 individuals: 1 adult patient is seen at an AMC each month
Key challenge to AMCs: Clinical Relevance
2001 … Out of every 1000 individuals: 1 adult patient is seen at an AMC each month
Why wait for reform? Conclusion: Academic medical centers must
restructure and reorient their clinical activities now
Opportunities for AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Distractions – By other worthy aspects of AMC mission • Competition – With other providers in local markets
Opportunities for AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Maximize coverage for individuals in service area • Align with providers with better payer mix
• Distractions – By other worthy aspects of AMC mission • Competition – With other providers in local markets
Opportunities for AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Maximize coverage for individuals in service area • Align with providers with better payer mix
• Distractions – By other worthy aspects of AMC mission • Connect clinical work to interprofessional education • Emphasize clinical / comparative effectiveness research
• Competition – With other providers in local markets
Opportunities for AMC Clinical Activities • Location, location, location – Predominantly in urban centers • Maximize coverage for individuals in service area • Align with providers with better payer mix
• Distractions – By other worthy aspects of AMC mission • Connect clinical work to interprofessional education • Emphasize clinical / comparative effectiveness research
• Competition – With other providers in local markets • Collaborate to yield clinical synergies • Focus on patient/population demands
Patient Protection and Affordable Care Act - 2010
Patient Protection and Affordable Care Act - 2010
How does the PPACA affect AMCs’ clinical goals and activities?
PPACA and Opportunities for AMCs’ Clinical Reorientation • Location, location, location – Predominantly in urban centers • Maximize coverage for individuals in service area • Align with providers with better payer mix
ACA+ ACA+
• Distractions – By other worthy aspects of AMC mission ACA+ • Connect clinical work to interprofessional education • Emphasize clinical / comparative effectiveness research ACA+ • Competition – With other providers in local markets • Collaborate to yield clinical synergies • Focus on patient/population demands
ACA+ ACA+
PPACA and Opportunities for AMCs’ Clinical Reorientation • Maximizing coverage – Through expansions in coverage opportunities – AMCs: Devote resources to assisting individuals with finding coverage • Improving providers’ payer mix – Understand local providers and align with those with better payer mix – AMCs: Enhance referral base and relationships with providers beyond the AMC walls
PPACA and Opportunities for AMCs’ Clinical Reorientation • Collaboration rather than competition – Through expanded clinical and community networks within and beyond financial relationships – AMCs: Understand community providers and organizations whose collaborations will enhance clinical care and improve outcomes • Be open to new synergies – Measure and respond to patient/population expectations and demands – AMCs: Take leadership role and accountability for population health trends and outcomes
Inspired by the mission, Squeezed by the market
Inspired by the mission, Academic medical centers Energized by healthcare reform
