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The Future of Academic Medicine
Peter L. Slavin, MDPresident, Massachusetts General Hospital
Professor, Health Care Policy, Harvard Medical School
August 6, 2015
Agenda
Health Care in the United States
Benefits of Academic Medical Centers
MGH at a Glance
How We are Bending the Cost Curve
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THE US HEALTH CARE ENVIRONMENT
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Health Care Costs are High – and Rising
1960 – $30 billion
1980 – $200 billion
2000 – $1.3 trillion – or 15% of GDP
2013 - $2.9 trillion – or 17.4% of GDP
2020 – estimated $4.6 trillion – 19.8% of GDP
Source: Centers for Medicare and Medicaid Services, 2013
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U.S. Health Care Costs In 2013, the United States spent $2.9 trillion, or 17.4
percent of gross domestic product (GDP), on health care – translates to $8,915 per person annually
Projections for health care costs in 2020 are $4.64 trillion, or 19.8 percent of GDP, which would be $13,708 per person
U.S. spends more on health care than any other developed country, but unlike countries that provide universal coverage, 13.4 percent of Americans are uninsured
Vital for hospitals to do what they can to take costs out of the system
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Rising Health Care Costs have Squeezed Employers and Employees for Years
Cumulative Increases in National Health Care Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings, 1999-2014
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2014.
High Costs – Difficult Choices
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Politicians must address tough questions about limited resources. How many teachers are you willing to fire in order to have 78-year olds have a procedure which will be invented five years from now that adds four months to their life? That sounds terrible, but infinitely choosing those things will shift you away from education for the young, and towards infinite invention of such [medical] procedures.
Bill GatesFinancial TimesFebruary 22, 2011
ACADEMIC MEDICAL CENTERS
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AMCs have Higher Average Costs
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3,974 3,984 3,993
2,214 1,389 985
2,360
674 260
8,548
6,047
5,238
0
2,000
4,000
6,000
8,000
10,000
AHC Other Teaching Hospital Type Other Urban Community
Cost Per Case, 1998
Multiple Mission
Wages & Case Mix
Base
Source: Analysis of American Hospital Association data by the Lewin Group, 1998.
What Makes Up Those Higher Costs?
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Standby capacity refers to capacity to provide high-technology or intensive services when needed.Source: Analysis of American Hospital Association data by Lewin Group, 1998.
Standby Capac-ity*45%
Research13%
Indirect Medical Education Costs
42%
Distribution of Mission-Related Costs for AHCs, 1998
Teaching Hospitals, an Economic Engine
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Source: Conference of Boston Teaching Hospitals
Academic Medical Centers…
Have higher mission and personnel-related costs
Are research powerhouses
Garner support from a multitude of benefactors
Train future health care leaders
Provide thousands of jobs and drive the economy
Have the potential to transform the health care environment
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MASSACHUSETTS GENERAL HOSPITAL
Our Mission
Guided by the needs of our patients and their families, we aim to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and to improve the health and well-being of the diverse communities we serve.
Two Key Affiliations
1811 –
1994 –
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Clinical Services
MGH offers care in primary care and virtually every medical and surgical specialty and subspecialty
Multiple specialized intensive care units to care for sickest patients
1 in 6 patients transferred from other hospitals Level-1 trauma center and advanced emergency
preparedness system
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Facts and Figures (2014)999 available beds49,334 inpatient admissionsMore than 41,000 surgical cases3,950 births a yearMore than 1.6 million outpatient and emergency
visits At least 300,000 of these visits take place at a
community health center
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MGH Research Revenue by Sponsor MGH conducts the largest hospital-based
research program in the United States
Note: Research Activity, excluding Other Science and P&L deductions for capital and reserves. Net P&L revenue is $750M.
Sundry19%
DHHS46%
ARRA0%
Other Federal4%
Foundations7%
Non-Profit16%
Industry8%
State/Local0%
FY2014 Direct + Indirect Research Revenue by Sponsor =$739M
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Education at MGH More than 2,200 MGH doctors teach the next generation
of physicians as residents and fellows
The MGH provides Harvard Medical School students with approximately 500 “core clerkship” experiences
The MGH sponsors GME in 17 core specialties and offers 90 subspecialty GME training programs
MGH Institute of Health Professions offers graduate training to more than 900 students in nursing, communication science, physical therapy and imaging
Knight Nursing Center offers wide range of continuing education programs for staff in Patient Care Services
BENDING THE COST CURVE
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Preparing for the Future: MGH/MGPO Strategic Framework
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MGH/Partners HealthCare Aggressively Pursuing Ways to Reduce Costs
Leadership opportunity to bend cost curve Efforts to reduce health care spending not going
away – government and private sector being proactive
Our readiness to care for populations of patients
Our Approach: Varied technological interventions Population Health Initiatives
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Managing Health Care Costs by Managing Populations
Inpatient and Outpatient Encounters
Episodes of Illness
Population Management
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New models to manage patients and deliver care
Targeted interventions address known issues
Success evaluated over years of work—we strategize and experiment to address issues that face our population and our communities
CMS Demonstration Project Starting in 2006, targeted sickest 10% of Medicare
beneficiaries, responsible for 70% of Medicare spending Patients had multiple chronic conditions, benefit from ongoing
management Improved care coordination and communication between
patients and care team through care managers Effective deployment of advanced practitioners Outcomes:
Higher satisfaction for patients and providers Lower hospitalization rates Lower ED visit rates Lower mortality rates Lower cost of care
Expanded across Partners and to all Medicare patients covered by Pioneer ACO, and to some commercial patients
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Population Health Management
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Care of High-Risk Medicare Patients – iCMP
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Navigating the Patient Journey
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*Patient reported outcome measures
Demonstrating Value for Patient, Caregiver
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Navigating the Patient Journey: Progress
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eConsults Example: Cardiac CurbsideOnline Consult from PCP to Specialist
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Technology can Help Reduce Costs
Implementation of Epic for health records and revenue cycle—evolving beyond Meaningful Use.
Decision support tools to drive appropriate use of diagnostic tools and procedures.
Initiatives to reduce administrative burden to keep practitioners working at the top of their licenses.
Patients involved in their care through online portal—develops active, engaged consumers of health care.
Increasing use of Telehealth (virtual visits)—began in Psychiatry and extending into other areas.
Exploring opportunities to leverage big data with EDWs and data visualization tools.
Community Health Initiative: Substance Use Disorders
Prevalent issue in Massachusetts Complex, downstream effects Typically treated as episodes present in our ED More than 2,000 SUD patients admitted to MGH annually Longer length of stay, higher readmission rate
MGH has developed a multipronged, continuous care solution to address these issues: Multidisciplinary inpatient addiction consult team Community health center support, recovery coaches Connection to other community resources Tailored wellness plans
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Addiction
“The question is frequently asked: Why does a man become a drug addict? The answer is that he usually does not intend to. [The drug] wins by default. I tried it as a matter of curiosity… I ended up hooked. You don’t decide to be an addict. One morning you wake up sick and you’re an addict. ”
William S. Burroughs, Junky (1953)
Natural History of Opioid Use DisorderW
ithdr
awal
Nor
mal
Eup
horia
Chronic useAcute use
Tolerance & Physical Dependence
Slide courtesy of Dan Alford, 2012
Substance Use Disorder: A national and a local problem
Illicit drug use: 24.6 million users 681,000 heroin users OD quadrupled since 1999
SUD: 21.6 million with SUD 2.5 mil (11%) treated
Boston Metro area: Highest ED visits for drugs Heroin 4 times higher
SAMHSA (2013) NSDUH Series H-48, HHS publication No. (SMA) 14-4863.SAMHSA (2011) NSDUH Series H-41, HHS publications No. (SMA) 11-4658.
What is Addiction?Primary, chronic brain disease characterized by
compulsive drug use despite harmful consequences
American Society of Addiction Medicine. April 12, 2011. www.asam.orgNIDA. August, 2010. http://www.drugabuse.gov/publications/science-addiction
Diseased Heart
Decreased Heart Metabolism in Coronary Artery Disease
High
Low
Decreased Brain Metabolism in Addiction
Visualizing Recovery
Volkow et al. J. Neurosci., December 1, 2001, 21(23):9414–9418
Normal
Reduced function
Return to normal
A Chronic & Treatable Disease
NIDA. Principles of Drug Addiction Treatment. 2012. McLellan et al., JAMA, 284:1689-1695, 2000 .
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Comprehensive Approach: From Prevention to Chronic Disease Management
Inpatient(ACT)
OutpatientCommunit
y
Recovery Coaches
Bridge Clinic
Prevention, Education & Evaluation
Maintaining and Building Referrals Network
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Expanding Regional and Global Outreach
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MGH Cancer Center: Toward Integrated Cancer Research and Clinical Care
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Targeted Therapies: Changing Standard of Care for Common Malignancies
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Selecting Targeted Therapies Based on Genetic Abnormalities Within Each Tumor
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Termeer Center at MGH
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Termeer Center Efforts
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The Future of Academic Medicine
Pursue four pronged mission: Care, Research, Education, Community Health
Deliver clinical excellence Advance our knowledge of human biology to improve
prevention, diagnosis, and treatment of human disease Innovate in care delivery to improve care and make it
more affordable
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