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Dome - Answering the health care reform challenge

January 2012

Answering the health care reform challenge

Date: January 10, 2012

Edward D. Miller

About a month ago, Darrell Kirch, M.D., president of the Association of American Medical Colleges, came to our campus to present his view on the urgent need for realistic health care reform and why academic medical centers have to lead that effort.

Dr. Kirch made a compelling argument for why the country needs a new model for delivering health care, and why we can’t wait for government, which remains mired in political gridlock, to carry out meaningful reform.

He stated the case that academic medical centers, because they’re leaders in innovative patient care, research and medical education, are in a unique position to take on the task of changing health care practices. However, Dr. Kirch emphasized that we’re at the point where it’s vital for these centers to change their models, to think in a vastly different way about how they deliver care, conduct research, and impart medical education and training. But most importantly, I think, he said they have to change their traditional structure and way of doing business.

Well, we’re there. In fact, Dr. Kirch acknowledged that when he mentioned our recent restructuring—JHM 3.0—and how we’ve integrated other hospitals (we now have six) and expanded our primary care network to more than 30 sites. He noted how we stuck with our home care service and grew our managed care business to more than 300,000 members and $1.5 billion in revenue, and how we developed our revolutionary Genes to Society medical education curriculum and created our cross-disciplinary research institutes focusing on disease-specific science.

All of this is why Dr. Kirch believes that Johns Hopkins Medicine can lead the way in reforming academic medicine and ultimately heath care delivery.

But then Dr. Kirch threw down a very provocative challenge. He asked us if we had the will to lead this change.

There’s no question in my mind that we do, and let me tell you why. We have people, such as the clinical directors and senior administrators and executives with the passion and creativity to think differently, the commitment and courage to carry out new ideas, and a track record of innovative accomplishments.

To me, the clinical chiefs are key. For example, you don’t have to look any further than Julie Freischlag (Department of Surgery director) and Mike Weisfeldt (Department of Medicine director) to prove that. If you look at the culture of the academic medical center of the future as Dr. Kirch presented it—collaborative, team-based, service-based, mutually accountable and patient-centered—Julie certainly has brought that to a department that had forever been the epitome of the traditional culture—top-down, expert-centric and autonomous. She gets it.

Mike Weisfeldt understood that waiting for sickle cell patients to have a crisis and end up in the ED and then in the hospital was costly and inefficient. So he worked with others to create a sickle cell outpatient clinic where patients can work with a nurse practitioner to manage their disease before it becomes a crisis. Paul Scheel, director of nephrology, knew that managing a critical renal dialysis patient was costing $65,000 a year because of frequent rehospitalizations. He changed things. Now, every one of these patients has a nurse practitioner to monitor their conditions and prevent trips to the hospital. In three years, he’s cut the cost of treating these patients by 45 percent. He was successful because Mike supported what he was doing. Mike gets it. Paul gets it.

If you know that you’re up to a patient population of more than 300,000 and stay slightly profitable, can you go to 600,000? Can you go to a million without adding a lot of extra resources?

We restructured Johns Hopkins Medicine to be that new academic medicine model that Dr. Kirch said is vital to the future of reform. With it, we’ll be quicker in making decisions to respond to the shifting demands of health care. We’re implementing a universal electronic patient record, Epic, that will connect all of our patients and providers and create a vast repository of data that we can mine to continue thinking differently about delivering care.

We have that will to lead change. It’s in our heritage.