Academic Heath Center Integration. Strategies for Synergy with the Academic Core

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1 Amy O Brien Ladner, MD Professor, Interim Chair Department of Medicine University of Kansas SOM Academic Heath Center Integration Combination of all domains Clinical Research Educational Hospital (at least one) Advantages size unique services and market prominence *infrastructure built for scholarly activity and dissemination of such

2 What will your Academic Health Center of the future look like and how will it contribute to academic endeavors including population health? How will the relationships between health centers and faculty practices/careers need to evolve? How will AHCs relate to community based affiliates? What internal processes and organization models will be necessary to undertake the many changes needed? Nature 453, (2008)

3 Changing Institutional culture starts with the leadership and commitment of top decision makers in the institution We must align the motivations and goals of our faculty, researchers, clinicians and community members in support of a common goal of a healthier population Medical directorships Metrics around quality, outreach Focused efforts around relationships Providers, community, social media

4 Academic advantages Improving health is our charge Community engaged research (CEnR) CTSA, PCORI, CMS, Payers Fill gaps in declining Research funding sources Provide scholarly opportunities leading to successful academic careers and promotion

5 Health disparities that lead to uneven access and quality and high costs will persist without a CEnR agenda Turning scientific discoveries into clinical advances often is an inefficient process due to insufficient resources and too few specially trained researchers AHCs are positioned clinically and scientifically to intervene and benefit directly

6 Barriers: Historical structures and processes of an AHC IRBs accounting practices indirect funding policies strict methodologies tenure and promotion pathways Defining community Identify partners Learn the etiquette of community engagement Assure network of dedicated researchers recognizing new methodologies translation dissemination of plans Acad Med.2012 March;87 (3)

7 Clinical Science Translation Award (CTSA,62 in 30 states) Speed translation of basic science into clinical application develop innovative solutions that will improve the efficiency, quality and impact of the process for turning observations in the laboratory, clinic and community into interventions that improve the health of individuals and the public The Patient Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization located in Washington, DC, was authorized by Congress in 2010 Comparative Clinical Effectiveness Research (CER) Studies that compare outcomes to determine the effectiveness, including risks and benefits, of two or more approaches to health care CER Methods and Infrastructure Studies to improve the methods available for patient centered CER Conditions Studied: underserved, rare, widespread

8 PCORI Conditions that affect large numbers Conditions that place a heavy burden on individuals, families, specific populations, and society Rare diseases, which are difficult to study Populations of Interest Racial and ethnic minorities Older adults Low income Residents of rural areas Women, Children Individuals with special healthcare needs, including individuals with disabilities, individuals with multiple chronic diseases, individuals with rare diseases, and individuals whose genetic makeup affects their medical outcomes Patients with low health literacy/numeracy and limited English proficiency Lesbian, gay, bisexual, transgender (LGBT) persons Veterans and members of the armed forces and their families PCORI Funding Eligibility: Nonprofit research organizations For profit research organizations Public Sector Universities and colleges Hospitals and healthcare systems Laboratories and manufacturers Units of state, local, or federal government US Organizations; must be recognized by the Internal Revenue Service Foreign and Nondomestic Components of US Organizations demonstrable benefit to the US healthcare system opportunities

9 CMS Innovation Award: supporting public and private organizations in four defined areas that have a high likelihood of driving health care system transformation and delivering better outcomes 1. Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post acute settings 2. Models that improve care for populations with specialized needs 3. Models that test approaches for specific types of providers to transform their financial and clinical models 4. Models that improve the health of populations defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting The University of Kansas Hospital Authority will test a model to implement the Rural Clinically Integrated Network (RCIN) to Improve Heart Health and Stroke Survival for Rural Kansas Form a collaborative governance structure to create a trust environment through which independent providers serving Northwest Kansas can define and refine the entire care continuum for that population Through clinical integration, these providers from the hometown primary care physician to the stateʹs academic medical center will become a team accountable for population health The RCIN will develop ʺregional hubsʺ staffed by providers and health coaches serving multiple communities Similarly, RCIN members will pursue collaborative implementation of clinical interventions to improve care and lower costs.

10 Initially, the RCIN will focus on patients at risk for or suffer from heart attack or stroke, including deployment of collaborative guidelines, pathways, and patient engagement strategies KU RCIN will implement ST elevation myocardial infarction and stroke regional systems of care. The RCIN will expand use of telehealth, robust health information exchange, ʺbig dataʺ analysis, and population health management, all in ways a single provider could not accomplish The final awards range in value from an expected $2 million to $23.8 million over a three year period The KU RCIN project is a $12 million project 50% program effort/50% Each project will be monitored for measurable improvements in quality of care and savings Generated Care Innovation Awards

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12 Successful Partnerships BCBSKC shared saving plan Care coordination monthly fees Tools to assess cost & quality care opportunities Two 50K grants to faculty to run research outcome projects: obesity BCBS KC dedicated 1 FTE nurse care coordinator to support patients in practice with care coordination needs Discussion:

13 PCORI EXAMPLE