September 20, 2012

VUMC poised to lead as health care reform evolves

Congress has not yet figured out how to reduce the national debt without slashing health care spending and research. How will Vanderbilt University Medical Center respond?

Congress has not yet figured out how to reduce the national debt without slashing health care spending and research. How will Vanderbilt University Medical Center respond?

“There’s no way for us to hide,” said Jeff Balser, M.D., Ph.D., Vanderbilt’s vice chancellor for Health Affairs and dean of the School of Medicine “What we are going to do is push forward … We’re going to lead … We’re going to set the standard.”

Jeff Balser, M.D., Ph.D., talks about Vanderbilt’s role in reshaping health care at Tuesday’s State of the Medical Center address. (photo by Anne Rayner)

In his hourlong State of the Medical Center address on Tuesday, Balser laid out the framework for the strategy that is already well under way.

In the past 12 months, for example, Vanderbilt has affiliated with Maury Regional Medical Center in Columbia, NorthCrest Medical Center in Springfield, Williamson Medical Center in Franklin, and Cookeville Regional Medical Center.

“These affiliation agreements are critical,” Balser said. “The way health care is working, you can’t just care for patients while they’re here under your roof. We’re actually going to be accountable for the care for patients no matter where they are in our region.”

An example of innovative leadership that enables this approach to care is MyHealthTeam, which allows outpatients to continuously interact with their health care providers so they can achieve better control of chronic diseases including high blood pressure, heart failure and diabetes.

The federal government recently awarded Vanderbilt an $18.8 million grant to expand the program to its affiliate medical centers in Columbia, Springfield and Franklin. Balser predicted the project not only will benefit up to 70,000 patients, but may cut health costs by $27 million over three years.

By the beginning of 2014, construction of a new outpatient campus in Williamson County should begin, and the Vanderbilt Heart and Vascular Institute will move into expanded space on the fifth floor of the Critical Care Tower. The Heart Institute, Balser said, is now “No. 1 in the marketplace.”

Advances also are being made in system-supported care with decision support. Since 2005, for example, evidence-based order sets for patients on ventilators in the ICU has dramatically cut the incidence of ventilator-acquired pneumonias, to the lowest in the nation, and saved an estimated $23 million, Balser said.

Similarly, Vanderbilt’s Diagnostic Management Teams, which provide real-time pathology support to clinicians at the time they are ordering tests for patients, are reducing the number of tests needed — and reducing costs.

Such a program, if implemented nationwide just for patients with lymphoma and leukemia, could save nearly $500 million a year, Balser said. “This is just to give you a glimpse of what health care is going to be like and how innovation is letting us do things much less expensively and much more effectively,” he said.

In the realm of personalized medicine, more than 9,000 patients have benefited to date from Vanderbilt’s PREDICT program, which is using genetic screening to determine which drugs are most likely to work for them and which will have the fewest side effects.

PREDICT began with the anti-platelet drug clopidogrel and the cholesterol-lowering drug simvastatin, and will be expanded soon to include a host of other drugs, Balser said. “We are the very first medical center to do this in a way that scales across the health system and which is accessible to patients,” he said.

Similarly, Vanderbilt has become the world leader in matching drugs to specific tumors based on their genetic sequence, Balser said.

This program, called MyCancerGenome, is now being used by oncologists in 128 countries around the world.

“Folks, this is the new Vanderbilt health system,” he said. “We are directly impacting how patients are cared for all over the world. This is what we are called to do.”

Balser introduced the latest installment in the Medical Center’s national advertising campaign — the story of a patient who sought out Vanderbilt for treatment for her brain tumor because “she wanted the best.” She relates her experiences with extraordinary people who cared for her as a person.

“That’s personalized medicine,” Balser said. “We do have extraordinary technology. We have extraordinary capabilities, but the magic behind personalized medicine at Vanderbilt is heart… That’s what’s special about this place.”