Duke University Medical Center


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a part of "The Path Forward for Academic Medical Centers: Innovation", Economics and Better Health, an Economic Studies and Engelberg Center for Health Care Reform event at the Brookings Institutuion

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Duke University Medical Center

  1. 1. An Overall Vision for AMCs in Healthcare Reform The Brookings Institution April 27, 2009 Victor J Dzau, MD CEO, Duke University Health System Chancellor for Health Affairs, Duke University
  2. 2. Agenda • Introduction: Challenges in healthcare • Healthcare Reform • AMC must evolve to AHS • The Innovation-Care Continuum: – Personalized medicine – New models of care delivery – Prevention • Final Thoughts: Today AMCs → tomorrow AAHCOs?
  3. 3. Healthcare & Medicine need transformation • Rising healthcare costs, diminished access •Fragmentation of care • Misaligned incentives • Emphasis on late-stage disease, not on prevention • Increasing difficulty developing novel therapies •Persistent heath inequalities – both local & global
  4. 4. AMC: External Pressures • Public trust • Government budget is tight • Demand for care & services rising • Frustrated with existing inefficient healthcare delivery • Expect more accountability • Believe research can lead to solutions • Expect AMC to lead
  5. 5. Academic Health Systems as a leader in transformation Reorganization of biomedical research and health delivery into a seamless continuum from innovation to clinical delivery to community health. “Bench to Bedside to Population” • Integrated model of innovation-care continuum • Shift in institutional research priorities • Effective utilization of information + investment in IT • Efficient care delivery • Improved health outcomes
  6. 6. How? Create an aligned organization • Vertical Integration of care delivery • Horizontal Integration of discovery & translational sciences with community health • Partnerships & governance • Need for a clear mission
  7. 7. AHS Needs Clear Vision & Mission Duke Medicine’s mission: “As a world-class academic and healthcare system, Duke Medicine strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future scientific and clinical leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.” Source: Duke Medicine 2006
  8. 8. Seamless integration: Innovation-Care Continuum Translation Global Clinical Discovery Translation and Adoption Health Research CURRENT AHS, Clinical Research HCS, Hospitals, Industry, Government, Industry, Organizations, Practices, FQHC, Biotech NGOs Biotech AHS AHS Current Timeline: 10-25 years? Duke Medicine (DUHS, SOM, SON) Basic & Global DUKE Duke Translational Duke Clinical Duke Center for Clinical Health Research Institute Research Institute Community Research Science Institute New Timeline: 7-10 years?
  9. 9. DTMI: Structure DTMI Administration Education & Training Ethics Pediatrics Biomedical Informatics Biostatistics Core Laboratories Regulatory Affairs Project Leaders and the Portal Office DTRI DCRI DCCR Duke as Site DCRU New Molecule Pre-clinical First in Human Development Phase II/III Application in the Community
  10. 10. The Integrated Matrix: Vertical Meets Horizontal Board of Directors AHS Executive Other Priority Priority Priority clinical disease disease disease academic area #1 Area #2 Area #3 groups Clinical Academic Groups EDUCATION & Area-Based Training and Education PRACTICE Source: Imperial College
  11. 11. Advancing Personalized Medicine • Personalized medicine can be major driver of healthcare reform • Realizing potential requires focus on translation, care delivery • Our commitment to personalized medicine: – Translational research – unique capabilities to design, manage “smart trials” – dedicated Clinical Genomics Studies Unit (CGSU) – (7) prospective studies of ‘omics-guided cancer therapy – study of impact of markers for DM risk on lifestyle change – strong record of industry partnerships – Care delivery – cancer chemotherapy treatment selection clinical pilot – “P5 Medicine” initiative
  12. 12. New Models of Primary Care • Innovative care arrangements – Medical homes – e.g., Community Care of North Carolina (Northern Piedmont CC) – “P5 Medicine” • Teamwork, “right-skilling” of labor force, IT – Duke Family Medicine • Novel educational approach • Improved financial incentives for providers – Encourages entry into the profession – e.g., UK NHS “bonuses” for GPs – Requires reimbursement reform
  13. 13. From AHSs to AAHCOs? • Responsible for the health of their communities • Able to redistribute resources to maximize prevention; and rates of early detection, Rx, f/u, patient self-management • With infrastructure for partnering w/ communities to reduce disparities, maintain continuity • CMS ACO demonstration projects
  14. 14. Clinical care at AHSs: Vertical integration of care delivery Community health partnerships Source: Duke Medicine
  15. 15. Vertically integrated care delivery 2° • Primary care 1° • In-home care GZ • Community care
  16. 16. AHS = matrix of horizontal, vertical integration Discovery Community and Clinical Research Global Health Translation Adoption