What is the role of a medical school in its community? Before Flexner it was real clear…Medical schools took the money of people who wanted the professional credibility of being a medical school graduate. They provided lectures and in exchange for money and attendance granted a certificate of completion. Abe Flexner’s report closed down all but a few of these schools, severely limiting access for students and creating a monopoly for educators. Over the intervening century, the medical school has been variously seen as a competitor to physicians in private practice, a resources for physicians in private practice, and mostly a little of both.

The medical school has morphed into the “Academic Health Center”  (likely in the 1980’s). This entity is defined as an accredited, degree granting institution of higher education that includes a medical school, one or more other healthcare related educational enterprise, and a relationship with (or ownership of) a teaching hospital. The Academic Health Centers, because of their perspective, have the potential to play an important role in transforming the care delivery system. They are integral to the training of our healthcare workforce, training some 200,000 learners each year. They play a key role in care delivery and research in many communities. Up until very recently, the potential was untapped. There are now several examples of the Academic Health Center making a measurable difference and a mechanism which will allow many more to do so.

Duke University is transforming their Academic Health Center into an Academic Health Science System. They define this as an integrated care delivery system that includes the traditional medical center, and also a network of community hospitals and practices.The goal of this system is to improve the health of the community.  To do so, they are transforming their organizational structure and re-evaluating their external partnerships, research emphasis, educational models, and information technology.  While they have many barriers yet to break down, I have seen some of their results and they are impressive.

Tulane was forced to rethink their mission and vision after Katrina. Immediately post-Katrina, they found themselves in a much smaller and less urban city. They changed their mission to “Education, Research, Patient Care: We Heal Communities”  and became deeply involved with the health of the community. Formerly centered at  the Tulane Medical Center and Charity Hospital sites, they saw an immediate need to provide health care services to those remaining in the city. They set up six community health clinics on an urgent basis. There are now eight total sites providing care to a low-income, ethnically diverse population. The new reality is now informing the totality of Tulane’s activities. I attended Tulane in the 1980s and can attest to the changed attitude.

Included in the Patient Protection and Afforfability Act is a mechanism to bring such change to more cities with medical schools. The creation of Healthcare Innovation Zones would allow all Academic Health Centers to coordinate care within its geographic community, encouraging innovation and positive outcomes. Academic Health Center leadership would make it more likely that the full range of services would be available to the population. Academic Health Centers are in the business of education and could provide leadership in system redesign to the rest of the community.

The ideal HIZ would include physician practices heavily on primary care and team based care, a mix of teaching and non-teaching hospitals, a distributed network of partnering outpatient facilities including FQHCs, post-acute care facilities, a range of public health and community services, and self management resources.

There are many regulatory, structural, and cultural hurdles to overcome before these types of system become routine. There is, though, the promise of redesign in the air.