Dr. Fred Sanflippo’s presentation on Academic Health Centers (AHC) provided a deeper insight on the alignment, innovation, and structure behind AHC models in our country. Before Dr. Sanflippo’s presentation, I always saw the hospitals, medical schools, and the development of medical plans as different entities. However, Dr. Sanflippo explained the dynamic variations of integrating these there entities in different AHC models, which ultimately impacts the quality of care a person receives in our health care system. AHC’s consist of three major components: hospitals, medical professional schools, and a clinical practice plan. Dr. Sanflippo explained how these three major components design 54 different models for AHCs. From least integrated to most integrated, there are 5 different levels of integration: Independent, Academic Enterprise, Separate Practice Plan, Clinical Enterprise, and the Fully Integrated model. Washington University medical center is an example of the Academic Enterprise model in which the Faculty Practice Plan (FPP) is responsible for overseeing the medical schools clinical mission and having physicians as members of the full-time faculty at the school of medicine (FPP WUSM). On the other hand, Harvard medicine embraces the Clinical Enterprise model in which a specific, clinical plan is practiced by all the staff in the hospital health care system. Emory Medicine is one of the few that model on a Fully Integrated system in which the hospital, clinical plan and education are interdependent upon the other to optimize the mission of care and performance for the patients.
While each level of integration applies to the various models for AHCs, will the changes in health care reform and Affordable Care Act (ACA) impact the way AHCs have been modeled throughout the years? According to Dr. Mary Hall and Dr. Kevin Grumbach, the Patient Protection and Affordable Care Act (PPACA) will change the way hospitals do business. Under the traditional fee-for-service business model, AHCs tend to value primary care physicians only as “feeders” of patients into the lucrative tertiary specialty care clinical enterprise. A high-performing primary care practice that keeps its patients out of the hospital and imaging suits may be scorned as “destroying demand.” (Hall and Grumbach, 2010). However, AHCs like OHSU are often more reliant on public sources of funding than their community hospital peers (see Figure 2), making them more vulnerable in an era of budget austerity and changes in the Health Reform which results in lower federal reimbursements and reduce spending for AHCs (Robertson, 2013). Thus, the dramatic changes in government funding and changes in the healthcare system pressure AHCs to become Accountable Care Organization (ACOs) with incentives of the Medicaid Shared Savings program. Dr. Hall and Dr. Grumbach further explained how high performing primary care practices will suddenly become a business asset to an AHC because AHC profitability will depend on achieving the best quality in the most cost-effective manner based on the PPACA. The changes of the healthcare system also call for a change in the education mission of many AHCs. The strongest influences on educational character of AHCs are NIH research funds and the traditional AHC patient care business model, both of which reward specialization and a narrow biomedical focus (Wennberg, 2002). According to Dr. Newton and Dr. Dubard, however, the changes in the health care system will provide an incentive to train more primary care residents as part of the move to expand the primary care base of clinical enterprise. We already see the changes taking place with many medical schools designing accelerated programs specifically for students taking interest in primary care. Although AHCs and Family Medicine have not always shared the same mission statements, the changes in health care are providing a greater opportunity to align with a common mission statement and understand the significant impact that primary care has on our country.
(FPP WUSM) https://fpp.wusm.wustl.edu/Pages/FPPPracticePlan.aspx
Hall, Mary, and Kevin Grumbach. “HEALTH REFORM, ACADEMIC HEALTH CENTERS, AND FAMILY MEDICINE.” The Annals of Family Medicine 8.6 (2010): 568-569.
Newton, Warren P., and C. Annette DuBard. “Shaping the future of academic health centers: the potential contributions of departments of family medicine.”The Annals of Family Medicine 4.suppl 1 (2006): S2-S11.
Robertson, Joe. “Health Care Reform: The Impact on Academic Health Centers.” Health Care Reform Insights: Thought Leadership Winter (2013) 3-13.
Wennberg, John E. “Unwarranted variations in healthcare delivery: implications for academic medical centres.” BMJ: British Medical Journal 325.7370 (2002): 961.