Align incentives
AMCs typically have multiple distinct entities such as a school of medicine, a health care delivery network, individual hospitals, a medical faculty practice, departments (eg, medicine, surgery), and individual divisions (eg, GI, renal, endocrine). By aligning incentives, maximizing the strengths and efficiencies of each entity, and developing a coordinated financial plan, AMCs can compete in regional markets. If AMCs are to succeed in the increasingly competitive health care market, there must be coordination and alignment at financial, governance, and operational levels in addition to the AMC working toward true clinical integration.
Operate at the speed of business
The pace of change at AMCs may be challenging. As we move to value-based reimbursement and note the emergence of large IDNs, barriers to clinical integration and financial alignment must be reduced swiftly. Aggregation of business processes, practice management, information transfer, and data collection and analysis all must be accomplished quickly. AMCs will meet this challenge with the type of intellectual tour de force we have witnessed during the last generation as applied to translational medical research. AMCs will lead in fields such as personalized medicine (pharmacogenomics, microbiome, cancer genetics), and through their clinical integration efforts they will emerge as leaders in coordinated population management as well.
Break down barriers between academic medical centers and community practice
American medicine has bifurcated care between AMCs that provide tertiary and quaternary care and community gastroenterology that provides primary and secondary care, although AMCs now are engaging in primary and secondary care as well. In a world where financial and outcome accountability for populations now will be paramount, cooperation along the entire spectrum of medical care will be needed. Traditional barriers between AMCs and community practices are beginning to fall as true integration of care emerges as a strategy for a sustainable IDN.
Academic gastroenterology: Looking forward
Academic gastroenterology comprises a unique blend of science and medicine. Certainly, there are deeply rooted traditions, many of which foster individual creativity and curiosity and provide a platform for diverse pathways and diversity. However, challenges exist, and open and transparent planning is necessary to meet and surmount these challenges. Successful AMCs will rise to these challenges.
References
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Dr. Rustgi is professor Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Dr. Allen is clinical chief of gastroenterology and hepatology and professor at the Yale School of Medicine. The authors disclose no conflicts.
