Academic medicine meets managed care

Abstract

The managed care revolution is sweeping the country as a result of intense marketing on the part of managed care organizations and the widespread belief that price-sensitive managed care systems will control health costs. Although few believe that managed care alone can adequately stem the growth of nation health care spending, competition based on price has emerged as a powerful force in the health care sector. Academic health center (AHCs) stand to suffer with this new managed care regime because their special missions of teaching, research, and highly specialized clinical care make them more expensive than nonacademic hospitals and place them at a noncompetitive disadvantage. The traditional focus of the acute care hospital with individual departmentally designed programs will be narrow. Major changes will be required on the part of AHCs if they are to survive and preserve patient volume, maintain the integrity of medical education, advance scientific research, and provide highly specialized care. AHCs will have to make unprecedented adjustments in virtually every phase of their operations, particularly in the areas of clinical decision making and speedy patient-related information flow. A premium will be placed on multidisciplinary, inclusive medical services that can assume total health care risks for large populations. New ways of educating students in ambulatory settings with an emphasis on outcomes and population-based health will be needed along with the traditional responsibility of pursuing new approaches to the diagnosis, treatment, and prevention of disease. The extent to which managed care will ultimately alter the traditional role of AHCs in the American health care system is unclear, but successful adaptation in the short term will require them to respond broadly, flexibly, and in a timely fashion to the anticipated health care scene.

Non–housestaff medicine services in academic centers: Models and challenges

“…The financial viability of AMCs has always been a topic of debate, largely because of the different missions they pursue and the financial means by which they survive. [31][32][33] Over the past decade, cuts in Medicare reimbursement, challenges in balancing bed availability with occupancy rates, and a growing emphasis on cost reduction have created a more competitive health care environment, but without the predicted demise of AMCs. 34 Because education and research generally fail to bolster the bottom line, AMCs have focused on optimizing clinical services to promote financial viability.…”

Academic Medical Centers: A Prescription for Success in an Era of Managed Care and Capitation.

“…The struggle to balance access, cost, and guality of healthcare within a price-competitive, market-driven environment has changed the nature of traditional healthcare institutions. Among these institutions, academic medical centers have been placed at maximum risk and stand to suffer the most as a result of managed care (Carey and Engelhard, 1996).…”

“…The medical group practice model used by many very successful academically oriented physician groups, such as the Mayo Clinic, offers a very promising approach (Kralewski et al, 1995) and is being used in some AMCs. This approach focuses on interdepartmental collaboration, development of programoriented centers, and a smooth interface between inpatient and outpatient services (Carey, and Engelhard, 1996).…”

“…These methods will be used for consultation, patient information transfer, and self learning (Carey and Engelhard, 1996) . For example, as home telemedicine systems mature, physical therapy can be administered, nutrition counseling conducted, and occupational therapy supervised via telemedicine (Schlachta, 1996).…”

“…Those AMCs that incorporate preventive health services and seize the opportunity to promote Wellness and good nutrition will have a better chance of success. The major responsibility for prevention clearly lies with the generalist, and primary care providers will have to be continuously educated about the latest information regarding efficiency and effectiveness of primary preventive measures (Carey and Engelhard, 1996).…”