Detmer dons thinking cap to diagnose state of health care
Equitable health care is a priority: ‘We are wasting money and need a sensible system’
Courtesy of Don Detmer
By Bob Beard
On a recent Tuesday, U.Va. professor of medical education Don E. Detmer (“my parents named me Don, not Donald,” he likes to say) was enjoying a few well-deserved days off at his farm in Crozet, playing with his grandson, taking an early morning horseback ride, enjoying the view of the mountains. But the current state of American health care — especially the plight of the uninsured — was not far from this surgeon’s agile brain.
Detmer aligns himself with one of the more controversial solutions to the health care crisis. “We deserve a values-driven health care system in the U.S.,” he said, “where all effective means of treatment — emphasis on effective and all — are available to everyone, not just people lucky or wealthy enough to have health insurance.” His push for a values-driven approach to health care — one that’s driven by humanitarian needs rather than a business model where the bottom line is everything — sprang from eight-plus years of discussion and debate within a small, informal think tank he founded soon after he served as vice president of the U.Va. Health Sciences Center, the forerunner of today’s Health System. Think of it as a smaller version of the Brookings Institution or Heritage Foundation, but for academic health care.
Once a year, the 15 or so members of the Blue Ridge Group gather with a few other experts to hash out solutions to the thorniest problems in the multitrillion-dollar health care industry. The group includes the chief executive officers of major academic health centers such as Johns Hopkins University; Emory School of Medicine; Oregon Health and Science University Hospital; the University of California, San Francisco; and U.Va., where Dr. Arthur “Tim” Garson Jr., vice president and dean of the School of Medicine, is a Blue Ridge participant. This year, the group meets in Jackson Hole, Wyo., for sessions on conflicts of interest in medical research and care.
“While participants may have a wide range of views on pressing issues, we wanted to get a group of bright, experienced people together to take a societal view of academic health care centers,” Detmer said. “Academic medical centers are pretty well-managed today. But how do you change them to make them more effective in terms of the three main areas these centers are renowned for: patient care, research and teaching? It’s hard to have all three areas performing optimally at the same time.”
To help major teaching centers do just that, Detmer and the Blue Ridge Group have come out with their first book for students, professors and health care managers. Called “The Academic Health Center: Leadership and Performance” (Cambridge University Press), the book is a compilation of the group’s work, a 300-page resource guide to values-driven health management.
Detmer said the book includes case studies of successes in academic health care that all hospitals and health professional schools can emulate. “Parkland Hospital in Dallas, for example, is focusing on the health care needs of the region and is bringing care to parts of the Dallas region that have been historically underserved. We also highlight the work of [current U.Va. Health System vice president and CEO] Ed Howell on leadership education at [the University of] Iowa — before he came to U.Va. — and the work Garson did at Baylor [University] on measuring clinical productivity. Values-driven management needs to spread across the country,” Detmer said.
But Detmer’s think-tank tome doesn’t just focus on bricks-and-mortar hospitals and the work in them. It takes a broad, macroeconomic view about what health care for a population should look like in centuries to come. “The U.S. needs to move to universal coverage for medical services that are proven to be effective,” Detmer stressed. “Why don’t we fix health problems early before people fall through the cracks or progress to serious illness? It makes both ethical and economic sense, since health care crises affect one’s job, pocketbook and family.”
Today’s health care institutions don’t think enough about health care for the entire population, Detmer said, and the need to manage the knowledge base through an aggressive use of computers, developing systems to assure that care is safe, efficient, patient-centered and timely.
“The societal focus is too much on health care costs and privacy and not enough on its broader benefits,” Detmer said. “Sufficient money is available today for health care to be done ‘right,’ but meanwhile we continue to waste billions through inefficient and ineffective policies and practices. The Blue Ridge Group is committed to fundamentally changing this state of affairs.”