Time to Rethink Where We Are


Many experts agree that the U.S. healthcare system is in the midst of its greatest period of uncertainty in a generation. We live in a dynamic health care delivery environment. Old paradigms focused almost exclusively on volume, driven by fee-for-service (FFS) reimbursement. New paradigms are evolving for health care delivery driven by value innovation – better outcomes for lower cost. Coincident with value-based care is a new emphasis on patient safety, evidence-based medicine and better coordination of care. The future is also likely to see new health care market segmentation with capitated populations co-existing with concierge-style care and traditional FFS payments.


Academic Health Centers (AHCs),  to which I have devoted my career thus far, are exceptionally vulnerable to these changes,  Having a tripartite mission:  clinical care, research, and the education of the next generation of physicians, introduces unique inefficiencies that community systems focused solely on clinical care do not face. It is challenging for an AHC to compete on price alone.  Society values the missions of the AHC, yet no entity wants to step up and pay the associated costs.


We need to find a sustainable way forward.

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