Faculty see key role for academic medicine in reducing cost of care
The new UCSF Center for Healthcare Value (CHV) has been created to promote and support initiatives that deliver high-quality healthcare at lower cost. The CHV also aims to develop a national model to harness the unique strengths of academic medical centers to increase healthcare value, and bring UCSF to the forefront in addressing unsustainable healthcare costs.
“This Center was created to address the reality that the U.S. healthcare system is providing limited value, while ever increasing costs stifle innovation and price many patients out of the system,” says Clay Johnston, MD, PhD, acting director of the Center and Associate Vice Chancellor of Research at UCSF. “Academic medicine is an untapped resource that is well-positioned to help, and offers an ideal environment to identify and test new ideas that improve care and foster innovation while also reducing costs.”
Academic medicine is an untapped resource that is well-positioned to help.Clay Johnston, MD, PhD, Acting Director of the CHV and Director of CTSI
Working groups of UCSF faculty are already making progress in crucial areas in conjunction with key partners such as the UCSF Medical Center, UC Hastings College of the Law, and The Grove Foundation, he added.
UCSF’s Clinical and Translational Science Institute (CTSI), also directed by Dr. Johnston, is leveraging existing resources and administrative infrastructure to help launch the CHV. Financial support for the Center comes from UCSF Office of the Chancellor and the UCSF School of Medicine Dean’s Office. Former Intel founder Andy Grove has also provided initial funding through his foundation, and has committed to future support based on the achievement of key milestones.
Prior to a planned official launch in early 2013, the CHV has built multi-disciplinary working groups around several initiatives to demonstrate success, which Johnston said “will help to differentiate the CHV as a do-tank rather than a think-tank.”
The initiatives include:
- Training: developing competencies, courses and curricula focused on cost and systems change;\
- Medical Center Initiative: tackling cost reduction projects that offer a 200%+ return on investment for the UCSF Medical Center over three years;
- Media & Culture Change: developing strategies to help clinicians and patients understand that less health care is often better care;
- Price Transparency: legal and data-driven approaches to exposing prices and reducing market inefficiencies;
- Systematic Reviews: proposing a centralized resource for technology assessments that include cost;
- Payer: exploring collaborations to define a framework for generating and testing innovative ideas to reduce cost while improving quality;
- Early Translational Research: reducing the cost of developing drugs, devices, diagnostics, and digital health (dHealth) by targeting development inefficiencies, and addressing the current economic environment that forces cost increases with each new innovation.
Leveraging Expertise & Partnerships
Among the team of UCSF faculty helping to build the CHV is R. Adams Dudley, MD, MBA, a Professor of Medicine and Health Policy at UCSF and Associate Director for Research at the University’s Philip R. Lee Institute for Health Policy Studies.
"As UCSF moves toward becoming a world leader in providing high value care, success will only be sustainable if the health care system as a whole rewards high value instead of high volume,” he said. “Right now, you get paid more for doing more. We’re looking at partnerships to demonstrate that the same or better outcomes can be achieved and sustained with payment that focuses on value. That could lead to wholesale change in the way the market functions."
A discussion of value must also include education, notes Chris Moriates, MD, a Clinical Instructor in the Division of Hospital Medicine at UCSF and an active member of the American College of Physicians High-Value, Cost-Conscious Care Curriculum Development Committee. During his residency training, he co-created a cost awareness curriculum for residents at UCSF.
"Academic medical centers have the unique opportunity to not only be stewards of high-value healthcare themselves, but also to teach and affect changes in the way that our medical students and trainees practice medicine,” he said.
In addition to seeking valuable input and participation from UCSF experts, this effort is also focused on building partnerships, said Lisa Schoonerman, Senior Program Manager for the CHV. Among the key partners are organizations that will be crucial to its success, including those that finance health services and have direct incentives to lower healthcare costs.
Through a partnership with the UCSF Medical Center and the UCSF School of Pharmacy, for example, the CHV is currently facilitating an effort to have patient medications delivered orally (PO), rather than intravenously (IV), when both are acceptable.
"The IV to PO project, led by School of Pharmacy faculty member Candy Tsourounis, demonstrates a relatively easy way to achieve significant cost savings while also improving the quality of care for patients by reducing the risk of infection and the discomfort associated with IVs,” she said. “It’s also an idea that can be shared and potentially replicated by other Medical Centers.”
The CHV is seeking ideas, input, and participation from UCSF faculty and potential partners. To get involved, or to sign up for regular email updates, contact Lisa Schoonerman.