The U-M Health System: Growing and innovating amid rapid health care change

A summary of UMHS efforts related to the Affordable Care Act... and beyond

Updated September 3, 2013

Whether you call it Obamacare, health care reform or the Affordable Care Act, there’s no getting around it: Federal and state-level changes are making these interesting times for health care providers, and those who train tomorrow’s health professionals – not to mention individuals and employers .

Change is the watchword of the day, as new programs encourage higher quality, lower costs, more technology, more partnering, and more accountability.

It’s also the watchword at the University of Michigan Health System -- which includes all of U-M’s hospitals and health centers, its Medical School and more than 25,000 doctors, scientists, staff, trainees and students involved in medical care, biomedical research and education.

Here are some examples of the ways UMHS is adapting to, and leading, health care change:

  • Showing how to provide better care to Medicare patients while containing cost growth: UMHS helped prove a fundamental concept of the Affordable Care Act, before the law even took effect. Back in 2005, the system’s physician group practice signed on for a five-year demonstration project that aimed to coordinate and improve care for people on Medicare who had U-M doctors as their primary care physicians.Just last year, an independent analysis showed that out of all the participating groups, U-M made the most progress in reducing costs, and substantially improved the quality of care patients received.  The gains were largest among patients who rely on both Medicare and Medicaid for their health coverage – a high-cost group of poor and disabled people that needs more coordinated care. The success of this demonstration led to a new federal program that lets doctors, hospitals, clinics and others form Accountable Care Organizations – cooperative efforts that can earn rewards from the Medicare system if they succeed in improving care and containing cost growth. U-M formed an ACO for its own 1,700-plus doctors, and hundreds of other local doctors, in 2012.
  • Bringing physicians statewide together to make care better and more affordable: For doctors across the state, taking part in the ACO movement might not be feasible on their own. But this year, UMHS helped launch an ACO that is helping more than 1,800 doctors across the Lower Peninsula take part in this important federal initiative and serve patients better. Called POM ACO, it aims to help doctors share in savings that they can achieve for the Medicare system – and help them improve the care they provide. UMHS also sponsors a statewide effort, the Michigan Surgical Quality Consortium, that helps doctors and hospitals pool data about the operations they perform and spot new ways to make surgery safer. MSQC recently won recognition from the federal government as a Patient Safety Organization, making it easier for more hospitals to join in.
  • Partnering with other health systems to ensure patients get the right care, at the right place and the right time: In the past year, UMHS has signed an affiliation with the four-hospital MidMichigan Health system, based in Midland, that includes the potential for a wide range of efforts to enhance care for patients treated at MidMichigan Health locations.In addition, under a master affiliation agreement with Trinity Health-Michigan, UMHS has partnered with Chelsea Community Hospital and Saint Joseph Mercy Health System to create new hospital inpatient capacity in the area. UMHS has also forged alliances with Sparrow Health System in Lansing for pediatric and medical helicopter services, and with local sub-acute care facilities. UMHS also has a longstanding relationship with the VA Ann Arbor Healthcare System, to provide care and perform research that enhances the health of our nation’s veterans.
  • Studying the potential and actual impact of the Affordable Care Act through impartial research:  Several years ago, UMHS and Blue Cross Blue Shield of Michigan formed a joint venture called the Center for Healthcare Research and Transformation, or CHRT. The center’s researchers have studied many issues related to the implementation of federal health law in Michigan. At www.chrt.org, they offer free reports on its potential impact on patients, employers, physicians and insurance companies.In addition to CHRT’s work, other U-M researchers have devoted themselves to studying issues related to health care reform. Also of note is the fact that a concept originally developed at U-M, “value-based insurance design”, has been incorporated into both the federal health reform law and the proposed expansion of Medicaid in Michigan. This concept, tested by U-M researchers and public and private employers nationwide, essentially makes sure that patients have the lowest-possible economic barriers to the preventive medications and tests that are most proven to enhance their health in the long term.
  • Educating tomorrow’s doctors to practice in a changed care environment: Recently, the U-M Medical School received a prestigious $1.1 million grant from the American Medical Association -- one of only 11 awarded under a national competition aimed at accelerating change in medical education. The grant will help the Medical School create a flexible new framework for medical students that will prepare them to lead change in health and health care in the dynamic global environment. At the same time, a major renovation of the Taubman Health Sciences Library to make it a hub for medical student learning that incorporates technology, clinical training and teamwork with other health professions, will begin soon.
  • Evaluating our community’s health needs, and serving them better: One of the lesser-known provisions of the federal law requires hospitals to take stock of what their local community’s health needs are, and create and update plans to serve them. Working together with the Saint Joseph Mercy Health System and the Washtenaw County Public Health Department, UMHS has already been taking the pulse of the county’s health needs for nearly two decades.  Now, in a report available at http://umhealth.me/CHNA13 , UMHS lays out what it will do to continue and improve its efforts to help county residents in seven priority areas: Access to care, mental health, substance abuse, obesity, pre-conceptual and perinatal health, immunizations and child abuse and neglect.
  • Building capacity to serve more patients: UMHS continues to experience strong year-over-year growth in the number of patient visits to clinics and emergency departments, and hospitalizations. With more individuals receiving health insurance coverage through the federal insurance exchanges and possibly Medicaid expansion, and continued demand from across the state for U-M’s advanced care, this will likely continue. In the current fiscal year alone, UMHS forecasts a 4.5 percent increase in patient care activity. To help ensure that UMHS care is available to those who most need it, U-M is investing in new facilities and systems to serve patients better. These include a large new multi-specialty health center in Northville, scheduled to open in July 2014, and continued renovation of existing buildings such as the Taubman Center to optimize care. Projects designed to help make care more efficient, so that more patients can be served in existing facilities, are under way throughout UMHS. At the same time, the federal health law has incentivized hospitals and physicians to adopt new health information technologies. A massive new electronic health information system is now in place at U-M’s outpatient locations and soon will be rolled out in the inpatient environment. Besides helping UMHS qualify for federal incentives, it makes possible a secure online “patient portal” that helps U-M patients get access to their records and appointment information while also communicating with their providers.

On many fronts, UMHS has been out ahead of, or riding the front of the wave, in health care reform. The coming year will be one of continued change as more uninsured people gain access to health insurance, and as other provisions take full effect.