2020 Vision Health in the 21st Century (1996) / Chapter Skim
Currently Skimming:
Institutions and Health
Institutions and Health
Pages 65-80
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From page 65... ...
This theme comes up throughout my remarks. The second factor is the shift in emphasis via capitation from providing medical services to sustaining health from managing care to managing health.
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From page 66... ...
These factors will provide a tremendous challenge to many institutions but none as much as academic medical centers. These venerable institutions will be particularly challenged by almost a Malthusian kind of process and will need to reinvent, reengineer, and "right-size" (or downsize)
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From page 67... ...
Gaining market power is a positioning strategy designed to increase or regain influence with purchasers who wall be the major buyers. Institutions will need to gain control in several respects.
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From page 68... ...
In my view, neither horizontal nor vertical integration, aside from the need to be a certain size, is essential to achieving increased market power or indispensability. At times, in fact, these can be counterproductive.
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From page 69... ...
Now, another strategy for institutions is to integrate upstream, or to integrate backward, and offer insurance products. Indeed' Medicare legislation proposed in both the House and the Senate would confer some advantages on provider organizations in actually becoming health plans and offering their services.
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From page 70... ...
and even academic medical centers, will also be responding to some of these for-profits. I discuss the capital part of that shortly.
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From page 71... ...
Some new instruments are needed. We are probably going to have to turn to the investment banking community to come up with some alternatives, particularly for not-for-profit groups to finance reserve and other system requirements for provider service organizations, as well as for information needs.
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From page 72... ...
The challenges facing medical centers are obviously major. Academic medical centers will need to redefine their mission and structure in order to coordinate clinical and academic enterprises.
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From page 73... ...
In some cases, these new realities will mean separating clinical enterprises from the university and from their state ownership. In many cases we may see a trend toward separation of the clinical parts of the academic medical centers from the medical schools, which will be less compromised in their mission.
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From page 74... ...
Dean, James Carroll Flippin Professor of Medical Science, and Professor of Medicine, University of Virginia School of Medicine , - y charge is to present a personal vision of health-related / institutions 25 years from now and to project the , ~ ~ ~ resultant changes in health. I shall confine my remarks to the institutions I know best: academic health centers.
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From page 75... ...
Details of organization and governance will differ among academic health centers. I predict that most of the centers that survive will have created an integrated clinical enterprise with smooth interface among the academic departments, their clinical practice plans, anti the teaching hospitals.
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From page 76... ...
This will lead to maximally efficient, effective, and timely care. Successful academic health centers will work with other network providers to respond to a diverse set of health needs that move beyond the walls of the traditional academic health center.
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From page 77... ...
Centers will become full partners on behalf of the health needs of society. SOME CONCLUSIONS Academic health centers, as well as the health system at large, are struggling with the medical, economic, social, political, ethical, and legal issues surrounding the current revolution in health care finance and delivery.
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From page 78... ...
From what we have heard from Congressman Porter, the discussion of the future of the academic health centers, and the total market orientation that is proposed, there seems little future for scientific medical research and, in effect, a declaration of resigning from that post. That may decrease scientific arrogance in this country, but it would also take us from the position of leadership that we have enjoyed for the last several decades.
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From page 79... ...
In terms of academic medical centers, having run one for a number of years, T can attest that rampant democracy floes not reign and that there are not a thousand points of veto in the way the United Kingdom runs its academic me(lical centers. In making these contrasts, I do not want to particularly draw attention to the United Kingdom.
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From page 80... ...
DR. LEWIN: We have much to learn.
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