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August 24, 2009
Academic health centers have opportunity to lead

Fred Sanfilippo is executive vice president for health affairs, CEO of the Woodruff Health Sciences Center and chairman of Emory Healthcare.

In 1910, working for the Carnegie Foundation, Abraham Flexner released a landmark report on the state of medical education in the United States. It was not good: students often were selected on the basis of their ability to pay without regard to prior education or experience. Teaching was largely by apprenticeship with physicians who had neither university affiliation nor background in the scientific basis of disease.

Flexner’s report became headline news, and in short order, it overhauled medical education. More than 50 medical schools were closed. Financial incentives fell into place for schools to adapt an academic model. The practice of U.S. medicine quickly transitioned from largely a skill-based trade to a knowledge-based profession.

Fast forward to 2009. With health care reform now in the national spotlight, we have the same opportunity to dramatically overhaul our health care system. Why we must do this is obvious. We have a wide and increasing range of problems that indicate significant and fundamental dysfunction in our system. Some argue that overall expenditures are too high for the value received. Some are concerned about what services are covered, and others see the large numbers of uninsured people as the problem.

Essentially, the concerns fall into three categories — costs, quality and access. But rather than three separate and clearly defined problems, they are complex and interrelated.

Who understands the depth, breadth and complexity of these issues as much as the nation’s academic health centers? As the traditional homes of innovation in health care, academic health centers like the Woodruff Health Sciences Center at Emory have a responsibility for addressing these concerns and engineering a better system. We must be fully engaged with the other stakeholders in making changes because true transformation will succeed only when all sectors — public/private, state/federal, employer/employee, academic/corporate — come together for the greater good.

In particular, academic health centers can guide policymakers to solutions for cost, quality and access. We can start by setting standards to reform financing and provide oversight. We can pay for quality and value in promoting health, not just treating disease. We can provide personalized, predictive care by engaging people to be participants in their own health. And we can restructure our delivery model to offer integrated health provider teams that allow each user to understand the risks and benefits of all options.

The magnitude of such change is no less than that of 100 years ago when the Flexner report changed the way medicine was taught and practiced. The challenges and opportunities of today are even more complex, and yet by closing the gap between our great understanding of health and disease and the application of such knowledge, we can transform health and healing together, as we are doing at the WHSC.

The promise of a health care system that is viewed by all as our nation’s greatest asset can and will be realized if academic health centers continue to lead the way.