Academic health centers (AHCs) are a critically important part of the U.S. health care system. Not only do they provide a significant amount of important tertiary and quaternary health care, but they also educate our physicians and other health care professionals, and do an enormous share of our medical research. The AAMC has been generating a lot of advocacy background to protect AHCs in an era of certain cost reductions, noting that AHCs estimate that they’re paid $0.75 on the dollar for Medicare services (big losses) and less than $0.60 on the dollar for Medicaid (bigger losses). NIH relies on AHCs for major research activities, and it would be a very ugly mess if we’re unable to train the next generation of health professionals to meet the expanded access to care that is occurring in health care reform. AAMC President Darrell Kirch MD has been doing his best to educate Congress about the threats to AHCs and about the growing shortage of health care professionals to meet the nation’s future needs.

I heard a brilliant presentation by Duke Health System’s President and CEO Victor Dzau FACC, who articulated parallel concerns for his prestigious institution very clearly. But Victor intends to act to re-invent the institution before it falls victim to radically changing circumstances.  In anticipation of the mega-changes all AHCs will face in the next decade, Duke has already been an innovator in these regards, restructuring their delivery system to vertically integrate ambulatory and inpatient care across the entire region they serve, and bring many hundreds of new physicians and community providers into their expanding networks. They have built many new ambulatory facilities spanning out into the community, as well as a number of “focus factory,” non-teaching surgery- and procedure-oriented centers. They are working on novel community care, quality network, and self care systems, including the Community Care of North Carolina system (CCNC), which offers a per-member, per-month payment subsidy for medical practices to coordinate care similar to the patient-centered medical home concept.

Dzau and Duke leaders, along with counterparts at Johns Hopkins, believe it will be necessary to streamline and re-organize the way research is conducted, along with achieving greater efficiencies in the entire health care delivery process. Duke is one of a number of AHCs across the country that is also reaching out globally to provide needed education and research services to the developing world, which not only provides needed services in such areas but also brings some margin back to the mothership in these difficult economic times. The ACC hopes that other AHCs are embarking upon similar innovative means to protect their viability in the tougher times just ahead.

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