Seizing the Health Care Reform Opportunity at our Doorstep

By Darrell G. Kirch, MD, AAMC President and CEO

From 2000 to 2006, I had the privilege of serving as senior vice president for health affairs, dean of the college of medicine, and chief executive officer of the Milton S. Hershey Medical Center at The Pennsylvania State University. During that time, we undertook a major overhaul of our health care system to improve care and lower costs. The efforts are outlined in an article in the March issue of Academic Medicine, “Employee Health Benefit Redesign at the Academic Health Center: A Case Study.” Given that most of the changes we made are still in place, it is clear the major lesson still stands: for academic medical centers, health reform opportunities lie at our own doorstop.

During my time at Penn State Hershey Medical Center (PSHMC), the national discussion that ultimately culminated in the passage of the Affordable Care Act was just beginning. What was painfully apparent was that the projections of our institutional spending on health care benefits for our faculty and staff presented a serious fiscal threat to our medical center. Between 2000 and 2005, we observed the health care costs of PSHMC rise at alarming double-digit rates. Equally painful was the fact that, when the data on our utilization of services were examined, opportunities to improve the health of our own people were being missed. For example, we found that routine preventive screening tests were being underutilized. As a self-insured institution, we were devoting more and more of our resources to “sick care,” which increased employee contribution rates and limited our ability to focus on wellness and prevention and improve the health of our community.

We recognized the irony of being an organization with a mission statement to improve health, while doing a poor job with our own “family.” A wonderful group of people from the physician practice plan, medical center administration, and the school of medicine came together to face this problem squarely, while also recognizing this as a unique opportunity to conduct our own organizational health care reform. As pointed out by my wise coauthors in our Academic Medicine article, what occurred was much more than a benefits redesign—we were able to achieve a fundamental shift from sick care to prevention and wellness while encouraging the use of PSHMC providers and services.

Critical to this success was a broad-based program we designed not only to inform faculty and staff of the changes, but also to empower them to become active change agents in the efforts under way. As with any major change initiative, some resistance did occur. But, in the end, individuals ranging from research-oriented subspecialists, to nurses on the frontlines of patient care, to employees in our dietary and maintenance services, became real stakeholders in improving our community’s health while also improving our financial situation. The details of our efforts are included in the article, but the key point is that, for academic medical centers around the nation, the best opportunity to achieve major change in the way we pay for and deliver health care while improving outcomes is right in front of them in their own employees and staff colleagues.

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