Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture

1
The Future of Academic Medicine
Peter L. Slavin, MD
President, 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
2

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

6
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 Gates
Financial Times
February 22, 2011

AMCs have Higher Average Costs
9
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?
10
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
Capacity*
45%
Research
13%
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
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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 beds
49,334 inpatient admissions
More than 41,000 surgical cases
3,950 births a year
More than 1.6 million outpatient and emergency
visits
 At least 300,000 of these visits take place at a
community health center

18
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.
Sundry
19%
DHHS
46%
ARRA
0%
Other Federal
4%
Foundations
7%
Non-Profit
16%
Industry
8%
State/Local
0%
FY2014 Direct + Indirect Research Revenue by Sponsor =$739M

19
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

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
22

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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 Curbside
Online 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.
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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 DisorderWithdrawalNormalEuphoria
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.org
NIDA. 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)
Outpatient
Communit
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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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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Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture

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Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture