Trustees agree UI medical enterprise needs realignment

CHICAGO — Consultants on Wednesday urged University of Illinois leaders to adapt quickly to a new health care model under Obamacare, and atop the list is addressing a "dysfunctional" organizational structure for its $1.2 billion medical enterprise.

At a retreat examining what President Bob Easter called the biggest changes in health care delivery in a century, trustees agreed to move swiftly to realign the UI's health system to make it more cohesive, efficient and "nimble."

"There is a sense of urgency," said Trustee Pamela Strobel. "It's a tremendous opportunity ahead of us."

Consultants from the Huron Group outlined several models, including keeping the vice president for health affairs position created just two years ago but with more clearly defined reporting lines and responsibilities; expanding the vice president's job to include academic oversight, which could diminish the health center's relationship to the Chicago campus; doing away with the vice president and returning to a vice chancellor for health affairs model under the UI Chicago chancellor; or investing most of that authority in the College of Medicine dean.

Another option raised the prospect of selling the UI Hospital, although that was not recommended.

The UI's complex and far-flung medical operations include the hospital, assorted clinics, a physician medical practice, the country's largest College of Medicine spread across four campuses, and associated health colleges, such as pharmacy, dentistry and nursing.

That broad footprint is a strength for the UI under the Affordable Care Act, which will require health enterprises to integrate patient care across medical fields and settings, from the hospital to rehab to home care, officials said Wednesday.

Under new Medicaid rules, payments will be "bundled" for various conditions, such as heart failure, rather than fees being paid to individual physicians, labs, hospitals and therapists. Private insurance companies are expected to follow that model eventually, too.

"Because of the breadth of programs here on this campus and beyond, we have an opportunity to be at the forefront of medical services" to those with limited resources, Easter said. More than a third of the UI's patients are covered by Medicaid, and the surrounding community is heavily Latino and African-American.

"You have all the pieces available to create new models of care and do it well," agreed Andrew Ziskind, managing director at the Huron Group, which is currently advising 30 public universities and academic medical centers.

But the changes will also require medical colleges and departments that have traditionally competed for resources to work together in new ways, officials said.

And the UI faces unique challenges — aging facilities, a "challenging payer mix," and a history of turnover and changing roles among its top leadership, consultants said.

Most recently, Dr. Joe G.N. "Skip" Garcia — appointed by former President Michael Hogan in 2011 to be the UI system's first vice president for health affairs — decided to take a new job as a senior vice president at the University of Arizona, after recruiting a half-dozen administrators to his UI team.

When Garcia's position was created, the reporting lines, accountability and in some cases the flow of money among the clinical operations, medical colleges, campus and vice president's office weren't clearly ironed out, Ziskind said.

"It was a setup for ambiguity," he said. "Everybody acknowledges there is a degree of organizational dysfunction right now."

Easter said later the position "started moving us in a necessary direction," but "we would have benefited from more conversations about what that direction was and what it meant."

The appointment of Jerry Bauman, dean of the UI College of Pharmacy, as interim vice president is critical for short-term stability and gives the UI time to move toward "organizational clarity," Ziskind said, but he urged trustees not to dawdle.

Because of the rapid changes taking place in Medicaid reimbursement and overall health finances, "the risk profile of the academic medical center has never been greater," said Huron President Jim Roth.

Research funding is flat or declining, schools are under tremendous pressure to keep tuition down, state funding is "uncertain at best," and hospital revenue is threatened as well, he said.

That puts greater emphasis on a good leadership structure and efficient operations, and health centers across the country are merging or realigning their operations, Ziskind said.

Some public academic medical centers that serve disadvantaged populations are considering selling their hospitals, but "we are not advocating that," he said.

The consultants said no particular structure is a panacea.

"The model itself doesn't dictate success. It's the degree of collaboration, mission alignment, culture, and to some extent things like resources," Ziskind said.

Earlier, Dr. Arthur Rubenstein, who engineered a turnaround at the University of Pennsylvania's health center, said the keys are clear goals, unified leadership, transparency and a culture of "collegiality and support."

Arguing internally about leadership roles and jurisdictions is "a waste of time" when the bigger challenges are external, he said.

Penn's medical enterprise had lost $500 million between 1997 and 2001 and considered selling its hospital, though faculty rejected that idea. Rubenstein brought in a "distributed leadership" model that required faculty chairs, department heads and other administrators to forgo some autonomy in favor of collaboration and shared responsibility for the institution.

He and his team outlined goals, charted progress, and set up clear lines of funding and responsibilities. It had to have tangible benefits so that "everyone had a stake in it" and an opportunity to contribute, he said. "That in particular changed the place and allowed us to go forward in a positive way."

Despite the challenges, Rubenstein said academic medical centers have a chance to reinvent themselves and improve health care and medical education.

"We are sitting on a historic opportunity," Easter agreed, saying he was buoyed by Wednesday's session. He hopes the board can discuss the issues further at its September meeting and make what could be "difficult but critical decisions" by November.

"We are at a time frame and situation where delaying for a year while we do another study is not going to achieve what we need to do," he said.

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jcm3r wrote on July 25, 2013 at 9:07 am

How is a hospital that has manage to stay in the black and not run a deficit for the past decade "dysfunctional?"  How many hospitals can claim the same?  The Board and UIC need to come to grips with the reality that UIC is always going to be #3 or #4 in Chicago behind Northwestern and U of Chicago.