Practice What You Teach: Academic Medical Centers and Responsible Health Care

By Sheldon M. Retchin, MD, Vice President for Health Sciences, Virginia Commonwealth University, and Chief Executive Officer, VCU Health System

As our nation ponders different models of health care to stem the rising tide of costs, high deductible plans have become increasingly popular instruments for engaging consumers in their own care decisions. With the availability of health care information on the rise and the number of public websites devoted to provider reports growing rapidly, consumerism for health care choice is no longer an empty pipe dream.

Patients are being rapidly transformed into active consumers, and they are seeking answers to thorny questions about the value and quality of care. If this consumer engagement is here to stay, it may well end up as a unique feature of an American brand of care. If so, what role will the nation’s academic medical centers play in this unfolding drama? Thus far, academic medicine has played a dominant part in the creation of advanced knowledge to benefit consumers, but we have had a trivial role in enhancing the understanding of information for consumers. As academic medical centers seek to convince consumers they are worthy of leading health care redesign efforts, and providing reformed care themselves, they are under the glare of a public spotlight. We may be a lot of things, but efficiency and wellness are not our strong suits, and there is nothing more damaging to the public confidence than insincerity.

Our response to the challenge of educating consumers about their health care choices may well be a defining moment for academic medicine. After all, we habitually teach our patients, our students, and our peers about the importance of prevention and evidence-based health care. Thus, the article in the March issue by Marshall and colleagues was a welcomed source of creativity and authenticity. Their experience in designing a benefit plan for more than nine thousand employees at a major academic health center is artfully described. Pay particular attention to the educational efforts by the leadership. No doubt this was part of the “secret sauce”. Not only were the reduced rates of cost escalation compelling, but so were the compliance rates for risk assessment and prevention. It would have been interesting if the authors had also reported on more salient outcomes as a result of the increased emphasis on lifestyle behaviors, such as smoking cessation rates or weight loss. Perhaps a future report could also provide further analyses of the diminished cost rate hikes for their health care benefit. Were the reduced rate increases a consequence of specific changes in care-seeking behaviors? Or, were they a result of improved employee wellness? The latter seems unlikely given the short time frame, but clarity would be helpful. Meanwhile, the authors have staked an important claim at a major academic health center—they committed to testing a new model of health care on themselves first. What better laboratory to practice what we teach?

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