Adam Reich: What I would hope to see is more and more academic hospitals and community hospitals creating almost a hybrid environment where they're sort of partnered together in one way or another and really sort of localizing care and sharing that expertise. This is obviously leaning heavily on technology, on clinical decision support models and those sorts of things that are going to. You can't do that on a one- to- one basis, which again, is one of the other problems of some of the traditional models, which are much more one- to- one physician to patient. We're going to need a lot more models where it's one- to- many, one expert providing expertise that's relevant and informative to tens or hundreds of patients.
Matthew Weinstock: That was Adam Reich laying out a vision for academic medical centers and community hospitals to forge tighter bonds in an effort to expand the reach of medical research and innovation. Reich is a Senior Vice President of Business Strategy at the Dana- Farber Cancer Institute in Boston. Among other things, he oversees long- range planning for the cancer center, which is a teaching hospital for Harvard Medical School. In this podcast, Reich and Oliver Wyman's Igor Belokrinitskyi explore the many challenges and opportunities facing academic medical centers. That includes a discussion about how these institutions may need to evolve from being destinations to reaching deeper into communities and allowing patients to stay closer to home. They also delve into ways AMCs can address financial and staffing pressures. The Oliver Wyman Health Podcast is brought to you by the global management consulting firm, Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health. oliverwyman. com. And now we pick things up with Reich talking about his background and role at the Dana- Farber Cancer Institute.
Adam: I'm the senior vice president of Business Strategy at the Dana- Farber Cancer Institute. Before joining Dana- Farber, I was in management consulting or strategy consulting for a bit over a decade. And at Dana- Farber, what I lead are a number of the different areas related to supporting our overall business strategy, our long- range planning, business development, and productization work, some of our access programs as well as market intelligence and performance improvement. So I have the great benefit of getting to work on a lot of very interesting things at really one of the most amazing and empowering organizations in cancer that exists.
Igor Belokrinitsky: Adam, we are grateful and delighted to have you with us and to get your perspective on this very important topic, the present and even more importantly, the future of academic medicine, of academic medical centers. And there's really no other institution like it that drives both the creation of knowledge and the dissemination of knowledge. The creation of knowledge through research and then dissemination through education and through applying that knowledge in the delivery of care and then creating the virtuous cycle of learning and kind of re- injecting it back into the system and rinsing and repeating. And so you have these amazing knowledge factories. They're so essential for society, but unfortunately the knowledge factories increasingly surrounded by noise factories and you're kind of trying to work across all of this noise that's also being generated, which arguably makes the mission even more important. So would love to hear your thoughts on kind of the role of AMCs and how it's evolving.
Adam: We really do feel and I feel that the role of academic medical centers is truly empowered by that virtuous cycle of the connection between research, education and clinical. It creates a lot of facilities constraint and spatial constraint and considerations to make sure that everyone really is co- located and near each other because being near each other in science, in academic organizations helps proliferate a lot of the ideas and strategies that emerge. What we are seeing is the world is becoming globally more connected and more accessible on the one hand. And at the same time, we see our patients and various individuals that we engage with and people that we engage with around the world looking for more and more rapid access to exactly what they're looking for, right? I think we're all seeing that in one form or another, and the same is true within academic medicine. To me, that means that academic medical centers are going to be increasingly becoming learning and education enterprises and organizations where the bench to bedside research that's done, the basic discovery that's done will further lead to new ways of engaging patients, engaging, let's say, the worried well on the outside that education expertise and best practices continuing to flow through and from academic medical centers as sort of thought leaders in that way. And then sort of elevating the tide across specialized areas like cancer really get on sort of a global scale.
Igor: That's a really compelling vision. Historically, academic medical centers have been destinations, and the deal was that you come to us and we do amazing medicine to you. But now I feel like the way healthcare has moved, the destination is the home, the destination is the consumer, the destination is my phone. And so how are you thinking about living in this new world where the destination is shifting and making it work and still being able to deliver this great care? Is it second opinion programs? What is the mechanism to bring this great knowledge to everyone?
Adam: Yeah, that's a great way of framing it, the contrast to destination healthcare, which definitely has been a big part of healthcare in some form or another for quite a while. We'll soon enough move away from that, from this concept of destination healthcare. It'll probably last for, I don't know, a decade more or whatever it might be. But eventually we'll progressively move farther away from it. I'll use the second opinions case that you gave as an example of that. Second opinions are a great service to many patients and highly recommended in many cases. However, there are a few fundamental issues with second opinion programs as a concept that encapsulate some of the changes I think are going to be coming down the pike.
One of the constraints is that many patients that need a second opinion don't get them. And again, I'm talking about in highly specialized areas. There are some patients that don't necessarily need a second opinion, but still do get them. But most importantly, second opinions, they're a single point in time. What patients are truly looking for and may well need in instances, again, where they have historically been looking for second opinions, what they're looking for is a way to expand their care team, to sort of, in an ongoing way, tap into expertise into the latest discoveries in the field that's relevant to their care and to their treatment, and to incorporate that expertise into how they're being treated. That's through the expansion of knowledge to the patient. It's expansion of knowledge to the caregivers that are around them, and obviously to the clinical teams that may be more local and are more hands- on involved in the delivery of care to them.
So, just sort of reflecting back on the broader question around destination healthcare, I do think we'll eventually see the same. When travel is needed, patients will of course travel, but more and more that expertise will be available to the local clinical teams as well. And patients around the world should, in some way or another, be able to get access to the same expertise that exists within the academic medical centers but in an environment that's closer to home.
Igor: I want to continue exploring this topic and thinking about this future where the center of gravity has shifted and it's less about destinations and there is a lack of resources to give access to everybody who wants and needs and could benefit from access. And there are access issues that we're seeing across leading institutions around the country driven, I think, at least partly by lack of clinician capacity and partly perhaps by how it's allocated. So that seems to be a huge, huge problem that is potentially getting worse. So your thoughts on this question of capacity, bandwidth, access as a kind of barrier for everyone getting great care?
Adam: Well, that's a great point. So I'll answer the question if it's okay thinking in the one extreme of the art of the possible, and then maybe let's go back to the art of reality or what I think is probably more likely. In terms of the art of the possible, what we have is a regional, national, international model where we haven't really matched up demand with supply. There are many, many doctors, many, many nurses. Some are more busy, some are less busy, some have more specialized expertise, some have less specialized expertise. There is within the realm of possibility models that could compel us more towards better allocation of the existing resources that we have. And almost in a sense like pooling of capacity and then disseminating that capacity. And I don't know that it's necessarily fair to say that there aren't the doctors, that there aren't the nurses.
I think it's sort of more reasonable to say that we haven't matched up the capacity that we have with where the demand exists. And so more practically, the ways that the academic medical centers will be able to help with the supply constraint in terms of expert clinical resources is doubling down on how academic institutions and sort of the leaders in the field within specialized areas partner with medical schools, partner with nursing schools, pharmacy schools, et cetera. As well as within continuing medical education and further and further making available, the latest discoveries, the latest recommendations in a way that, again, better disseminates and democratizes the expertise that they have. And so sort of leveling up and sharing the knowledge in a more equitable and more distributed way.
Igor: As you're describing these changes that are possible and that are necessary, I'm trying to envision this future landscape of academic medical centers. And I have this picture of being in the orbit at night and seeing the bright lights on the map. And there's obviously the hubs that presumably will always be hubs in places like Boston, places like Houston and Austin where they're the centers of academic medicine. There are some interesting new ventures. They're trying to go deep into certain regions like what Alice Walton is doing in Arkansas. There're medical cities in places like China where you can try new things out with fewer constraints. I'm curious, again, if you picture this map a few years from now, how is it different? Are there more academic medical centers? Are there fewer? Is it hub and spoke? Is it kind of across the board? Is it more of a virtual than a physical thing? How are you thinking this evolving?
Adam: I think there's a little bit of a sense that exists that the hubs of healthcare, so to speak, the large academic medical institutions or cities with a number of large academic medical institutions prefer to keep things that way. So let's say from our standpoint, our preference would be that we retain these great hubs that are packed as much as possible with patients. And the truth is is that it's quite difficult. It's really, really busy in these hubs. It's really hard to operate and it creates a lot of risk for burnout. Let's say doctors are busy, nurses are super busy. We'd love to work towards a model where healthcare was more distributed, where the access to expertise was more distributed. There haven't really been these great business models that have been established to recognize this need for almost like a care neighborhood. In other words, ways for academic institutions and community hospitals to sort of partner together.
The NCI has this sort of consortium. There's sort of different designations within the NCI for how one could be designated as a cancer center. One of those models is a consortium. Over time, what I would hope to see is more and more academic hospitals and community hospitals creating almost a hybrid environment where they're sort of partnered together in one way or another on really sort of localizing care and sharing that expertise. This is obviously leaning heavily on technology, on clinical decision support models and those sorts of things that are going to. You can't do that on a one- to- one basis, which again, is one of the other problems of some of the traditional models, which are much more one- to- one physician to patient. We're going to need a lot more models where it's one- to- many, one expert providing expertise that's relevant and informative to tens or hundreds of patients.
Igor: So when I think about academic medical centers, I don't think of giant buildings with technology, and I think of a tightrope walker and she has this balancing act of balancing between the missions, between education, research, clinical, community, and it's a really tough balancing act. And while she's walking this tightrope, she's also juggling. She's juggling the global commitments and the global competition an academic medical center has as it competes for talent and funding, the national, the regional, and the local commitments, and the need to compete and deliver and have impact at all of those levels. So tightrope, juggling multiple items, some of them potentially in fire, very, very difficult act to perform. And we have strong headwinds now and pressures and uncertainty in the world. And so your thoughts on how will the leading academic institutions manage this and continue juggling and moving forward?
Adam: I don't know that anybody knows the answer. And I think sort of anyone's guess is just as right as the others. I think what it's going to do is challenge the commitment that organizations have to their mission and purpose. For the organizations that are prepared to double down on their mission and are committed to research being at the core or a core of what academic medical centers are, that will require very creative models of alleviating funding needs to maintain the research mission and vision, and the same thing on the education side. We're going to need philanthropy and donors to step up. We'll need new and creative models of different types of grant funding. We're going to need to focus on research that is sort of highest and best order of priority.
For many, that might push them more towards translational or clinical research and away from basic research. For those that have had long history rooted in basic research, they're going to have to push even harder and dig even deeper to retain that commitment to basic research. And then again, back to the other end of the spectrum, those that are more driven by the realities of the day are going to probably shy a bit away from their histories on the research side. And the clinical piece will be easier to rationalize from a business case standpoint. And so we'll see some organizations that have had strong histories at research either quickly or slowly evolve towards more clinically oriented organizations. And so the balance of the three- part mission for academic medical centers at a national level, the relative balance of those three may look really different in even five years from now.
Igor: That's really fascinating. So you're adding a third balancing act to our tightrope walker. Also, she needs to think both in the near term, being very realistic about where the resource constraints are and where the strengths are, where the market needs are. And at the same time, thinking about the long- term and the great potential and where you've kind of started, the future ability to reach a lot more patience across both space and time. So not just reach people who are further away physically and geographically, but also to have a longitudinal lifelong relationship with them so you can make these great meaningful impacts on their duration and quality of life.
Adam: Healthcare is extremely fast and extremely slow at the same time. Innovation could happen very quickly. Introducing systemic change typically takes quite a while. And so the choices that we make today and the priorities that we're establishing today definitely will reverberate. And that certainly speaks to, again, the balance of missions and priorities, and it will factor in as well to how organizations think about near and far network strategies and then near and long- term growth strategies.
Igor: Adam, really grateful for fantastic and thought- provoking conversation. We'll be thinking about it for a long time going forward. Really appreciate it and thank you for all the great work you're doing.
Adam: Igor, thank you so much. Great to speak with you and always great to catch up.
Matthew: Thank you for listening to the Oliver Wyman Health Podcast. This podcast is brought to you by the global management consulting firm, Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
