The newly named senior vice president of health affairs for the University of Miami and CEO of its health system, UHealth, Steven Altschuler believes healthcare is at a turning point in America — and doctors, hospitals, insurance companies and patients all will be affected by change.
“Transformation is going to really accelerate,” said Altschuler, a mathematician and physician who served as chief executive of The Children’s Hospital of Philadelphia and its foundation for the past 15 years. Altschulder replaces Pascal Goldschmidt, who will remain as dean of UM’s Leonard M. Miller School of Medicine.
Alschuler, who seeks to build a network of doctors, hospitals and clinics in South Florida and beyond, sees challenges on the horizon. The most urgent, he says, is a radical change in the way doctors and hospitals are paid for their services — a switch from reimbursement for each individual service to payments for keeping patients healthy and out of the emergency room.
That change, he said, will hold doctors and hospitals accountable for maintaining quality and controlling costs, and force them to better coordinate patient care.
For an integrated system such as UHealth, which includes University of Miami Hospital, Sylvester Comprehensive Cancer Center, Bascom Palmer Eye Institute and a network of outpatient clinics and physician practices, the challenge becomes one of scale.
This is where the mathematician in Altschuler kicks in.
“If providers are going to have to take [financial] risks for the care they give,” he said, “it's important to have a very large population [of patients] so you can manage some of the inherent statistical risk.”
The best way to meet the challenge, Altschuler said, is with a broad network made up mostly of outpatient clinics that can deliver medical care to large numbers of people close to where they live.
UHealth already operates outpatient clinics in Miami-Dade, Broward, Palm Beach and Collier counties.
Given constant improvements in medical care and technology that allow physicians to treat their patients outside of a traditional hospital, UHealth likely will open even more outpatient clinics far beyond South Florida as it seeks to tap into the state’s growing population, Altschuler said.
“The vast majority of care that we deliver in the future,” he said, “can be done at one of those centers.”
To be sure, the traditional hospital will remain an important part of UHealth’s future. And Altschuler’s plans depend, in part, on a robust relationship with Miami-Dade’s public hospital network, Jackson Health System, a veritable factory of physician training that produces more doctors than any other center in the region.
“I think Jackson will be one of the most important relationships that the University of Miami has,” he said, “but there will have to be others.”
That means potential partnerships with other hospital systems throughout Florida, particularly when UHealth looks to extend its reach beyond Jackson’s mandated service area of Miami-Dade.
“Providers are really looking at all the options in terms of how they formulate networks, how they develop the scale,” he said.
One of the first items on Altschuler’s to-do list once he starts his new job in January: Meet with hospital leaders throughout South Florida “to really understand what their view of the future is and really try to assess what the environment is for collaboration.”
As he develops a strategy for UHealth’s future, Altschuler said, he is keeping his eye on some basic goals that will prepare UM’s health system for whatever comes down the road.
“Get the care model correct,” he said. “Get the standardization. Get the data we need to really formulate outcomes, and then you will be able to apply that to any type of system you want when it comes along.”