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How Academic Medicine Can Help

By Darrell G. Kirch and Edward D. Miller
Tuesday, September 22, 2009; 3:51 PM

Whatever version of health-care reform emerges, the legislation needs to address two problems with the health-care system: uncoordinated care among physicians, hospitals, and other providers; and a payment system that encourages often unnecessary care. Those of us on health-care's front lines think that these problems can be addressed effectively in "Health-care Innovation Zones" (HIZ's), proposed by Rep. Allyson Schwartz (D-Penn.) in a new bill.

In a Health-care Innovation Zone, a regional alliance consisting of an academic medical center, local hospitals, physicians and other health-care organizations coordinates and delivers the full spectrum of care in ways that reward quality. These Innovation Zones could also test new, more patient-centered models of care, such as the medical home and "accountable care organizations," as well as new payment models that have the potential to vastly improve care and reduce costs.

At Johns Hopkins Medicine, one of the nation's leading academic medical centers, the much-talked about theory of such new care and payment models is already being tested. The JHM alliance serves a large group of over 135,000 economically, medically and socially challenged Medicaid patients as well as close to 30,000 military beneficiaries and their families. Through a network of owned and contracted providers located across Maryland, and using tools such as predictive modeling, JHM has reduced expenditures for patients with highly complex medical needs and a history of substance abuse; reduced the total costs of caring for our patients with end-stage renal disease by 47 percent; exceeded national benchmarks on all measures of clinical quality for our dialysis population; reduced the odds of hospital admissions for patients at the end of life; and earned high patient satisfaction ratings across the state. Indeed, our member satisfaction for our military health plan is in the 98th percentile.

We believe that other academic medical centers, using all the tools that could be applied within a Health-care Innovation Zone, could achieve the same outcomes. Many academic medical centers already have aligned networks of faculty physicians and teaching hospitals. They already provide the full range of health services, from preventive care to the most complex. They already have cutting-edge technology and strong investments in health information technology. They already provide a disproportionate share of vital urban health services and nearly half of the nation's hospital-based charity care. And because they work in partnership with one another, they can share what works -- and what doesn't work. In short, academic medical centers should serve as the anchors of Health-care Innovation Zones and contributors to the rational redesign of our health care system.

Darrell G. Kirch is president and CEO of the Association of American Medical Colleges. Edward D. Miller is dean of the medical faculty and CEO of Johns Hopkins Medicine.

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