THE CHALLENGE: Why Disruptive Change is Necessary

Dan Rahn, M.D.

Doctors on a Dollar sign

The cost and quality of health care in the United States has been in upheaval for nearly a decade.

Uncontrolled growth in the cost of health care has put services out of reach for many people, intensifying the already uneven distribution of the burden of illness on society’s poor and less educated.

And the very health care system we participate in is failing to meet the health needs of society in fundamental ways through its complex nature and unacceptable variation in quality of care and cost.

In short, our health care system is in need of fundamental overhaul to achieve a triple aim of higher quality care, better patient experience and lower cost.

A healthier population is the infrastructure for everything good in life and society. Everyone in society benefits by having health care services available at the time and place of need. To proceed toward patient-centered affordable care, we must recognize the role that both health system factors and social determinants of health play in individual and population health.

Social determinants of health — the conditions in the places people live, learn, work and age —affect a range of health risks and outcomes. They are affected by economic conditions, education, housing, neighborhoods, environmental conditions, culture, availability of healthy foods and access to health care, among other things.

As the state’s only comprehensive academic health center, UAMS has an obligation to work toward meeting these challenges by embracing the complexity of all of the issues that impact health. This includes recognizing that biology and genetics play a large role in determining an individual’s health risks, but so do economic status, educational level, political forces, geography, cultural norms, nutrition, race, ethnicity and behavioral choices.

We simply must tackle the array of internal operating issues within UAMS, the rapid changes in our external operating environment, and the evolving factors impacting population health.

To do this we must transform and reengineer our organization to lead society toward a healthier future.

As a university, we are in the knowledge business with a long tradition of the concept of academic freedom. Yet, as an academic health center, we are in the health care business in which producing the best outcomes for patients requires teamwork, interdependency and shared goals.

Historically, as academic health centers have expanded their clinical enterprises, the revenue growth allowed them to subsidize the cost of scientific research and cost of educating the next generation of health care professionals.

But after decades of robust growth, that operating environment has changed. With the recession that began in 2007 and from which the United States has not fully recovered, state government has reduced funding for public higher education and the federal government has reduced funding for scientific research.

UAMS has not been immune from these trends. We have had to absorb reductions in our state appropriation and federal funding for both research and patient care.

That put pressure on the clinical enterprise to provide even more support for education and research at the same time that billions of dollars are being cut from Medicare. This is requiring the forging of new partnerships between health care organizations

This is a time of disruptive, transformational change in every aspect of health care and the financial models of academic health centers. At UAMS, it has allowed us to take bold steps in redesigning our clinical enterprise and our educational efforts. It has brought new leadership to the forefront to meet these challenges head on and ensure that UAMS emerges stronger to meet the health needs of Arkansans well into the future.

This optimistic outcome will not be possible, however, without partnerships and a broad recognition of the importance of a vibrant UAMS to the future of Arkansas.