Association Of American Medical Colleges Chair Calls For Health Care Transformation

Duke's Dr. Ralph Snyderman calls for health care institutes to focus more on "prospective health care"

SAN FRANCISCO -- Noting that American medicine now has the ability to radically improve health care while enhancing cost effectiveness, the chair of the Association of American Medical Colleges (AAMC) called upon its member institutions to begin to implement 'prospective health care,' an approach to care that focuses on individualized health planning, disease prevention and early intervention.

'Our nation is currently spending $1.5 trillion a year for health care, and it is not getting its money's worth. If done right, the development of a health care system that focuses on prospective health care will be every bit as transformational as the coupling of science to medicine was in the 20th century, but we need to develop new educational and delivery models,' said Ralph Snyderman, M.D., chair of the AAMC, in an address at the group's 113th Annual Meeting here today.

In fact, Snyderman, also chancellor for health affairs and president and CEO of Duke University Health System, called for an 'AAMC Institute on Prospective Care' to get this initiative rolling. 'We in academic medicine, in partnership with others, can lead the transformation of American health care. What we need to do is change the orientation of medicine from reactive to proactive, i.e. 'prospective health care,'' he said.

'We need to assess each individual's risk for developing disease, be able to detect the earliest onset of disease and prevent it, or intervene early enough to obtain maximal benefit. We can already do much of this, but we aren't because we are missing effective delivery systems and reimbursement mechanisms,' Snyderman said.

'The current practice of medicine is largely reactive rather than proactive. People go to the doctor when they are sick. As physicians, we are taught to identify the defect, whether it's molecular or structural, and fix it. Interventions are sporadic and heavily directed by physicians rather than in partnership with the patient. We have an uncoordinated delivery system, with the relationships amongst the parts not being synergistic. Costs are expensive and inefficiently deployed,' he said.

In addition, Snyderman noted we must keep the patient as the central focus in planning for their own health. He said patients today have an array of health care choices but are confused by the many options available, including complementary and alternative therapies.

The AAMC chair pointed to new advancements in health risk assessment and disease prevention as a new way to reorient the practice of medicine prospectively. 'The ability to assess risk, to identify the probability of disease occurring before it does, and to be able to do something about it is an emerging capability. Within the next 10 years, medicine will likely have the ability to determine each individual's risk for most common diseases, he said

'This will allow us to assess a person's susceptibility for such diseases as diabetes, coronary artery disease, breast cancer, prostate cancer, colon cancer and Alzheimer's at the time of birth. Think of the power this will give us in developing ways of predicting and preventing disease,' Snyderman said.

Even without the input of genomics, Snyderman continued, we currently have powerful tools to predict and treat disease early. 'We have the means now to prevent heart attacks, if people are willing to take appropriate tests, watch their diet, exercise, take aspirin and, depending on the individual, statins or other forms of therapy,' he said.

'What we need is for the practice of medicine to be proactive, predictive and individually planned. But in order for this to work, we will need to integrate our delivery systems to provide continuity and have patients very much involved in their own care. People will need to change and take far more responsibility for their own health in this new world,' he said.

'Much of what people need to do to improve their health will be based on their willingness to assume personal responsibility for their health. We will need to focus on patient education and motivation because we're trying to prevent things that have not yet occurred,' Snyderman said.

Snyderman noted the individualized health plans will help patients plan for the future. 'In addition to seeing patients when they have an illness, health providers will assess each person's current health status and then do a risk analysis based on genetic, environmental and lifestyle considerations. From this will be developed a health plan defining the best pathways for the patient to minimize the likelihood of developing disease or deal with it at a very early stage,' he said.

He continued that prospective health planning will need standards of care programs for identified risks, whether they be for chronic or acute diseases. It will also be necessary to have a provider team to facilitate the care of patients, especially those with chronic ailments. 'For individuals with congestive heart failure or diabetes, it is doubtful a single provider could handle all of the patient's needs. Instead, these patients will need access to a team of health care providers, including a care coordinator,' Snyderman said.

He noted that his institution, Duke, has been preparing to deal with and implement prospective health care ('Duke and Federal Government Partner to Create Innovative Health Care Model,' news release, Sept. 26, 2002). 'We continue to need research on how prospective care can best work. We need to develop funded pilot practice projects, so that we don't go broke trying to determine what works. Then, we'll have to develop effective delivery systems,' Snyderman said.

'Reimbursement systems do not support prospective programs currently, and this needs to change. To do so will require collaboration between providers and payers, particularly the federal government. The outcome will be a health care transformation leading to a healthier nation and far greater value for medical expenditures,' Snyderman concluded.