UTHA:Year One

CARING THAT MAKES A DIFFERENCE UT HEALTH AUSTIN: YEAR ONE

wh sta he chan th wo

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ess than 50 years after Texas secured its independence in 1836, the cornerstone of the University of Texas at Austin’s flagship building was ceremoniously set into place atop “College Hill.” While the “Old Main” building may be gone, the audacious spirit that envisioned a world-class university on what was essentially, at the time, the edge of the frontier, now invites medical experts, thought leaders and innovators to discover what lies beyond the crest of today’s health care horizon.

In June of 2016, the new Dell Medical School at The University of Texas at Austin welcomed its first class of students into a first of its kind education experience. Unlike in more traditional lecture- and memorization-based learning models, starting on the first day of their training, Dell Med students work in interdisciplinary teams to apply critical thinking and coordinated leadership skills to solve problems based on real-world patient histories. It is this core idea—that in our modern, informationrich world, physicians will create more value for patients when they lead integrated teams that are entirely focused on treating each patient as a complete, multifaceted individual—that we believe will change the health care experience for people and their communities in meaningful and obvious ways.

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UT Health Austin: Year One

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UT Health Austin: Everything we do, is focused on you.

On October 17, 2017 Dell Medical School faculty and staff began practicing what they teach as UT Health Austin, the interdisciplinary medical group practice that now delivers direct patient care in our state-of-the-art Health Transformation Building (HTB) located on Trinity Street in downtown Austin. Reflecting the thinking of hundreds of experienced medical and administrative professionals, there are three driving ideas behind everything we do:

1. Measuring what matters helps everyone get better: In health care “outcomes” have traditionally described aspects of the care patients receive from a doctor or in a hospital that are comparatively easy to measure, like how many days the average patient spends in the hospital for a particular condition, or the frequency with which medications were administered. While helpful, these “process” measures reflect only a portion of a patient’s health care experience. At UT Health Austin, we believe that it is also important to capture those outcome measures that are personally important in our patients. Such as your ability to do the things you hoped you would be able to do before you started your care; or if you felt informed during every phase of your treatment plan. By asking our patients what they value most, your UT Health Austin care team makes understanding your goals our priority, and meeting those goals the measure of our success.

2. Every patient, as an individual with unique circumstances, values and needs, is the center of their own, personalized care team: At UT Health Austin, we do everything we can to help our patients succeed. This means that we go beyond the care room to include such factors as your age, overall health, weight and other conditions in your care plan. We also take the time to understand your personal values, your preferences, and your beliefs to ensure that the details of your care align as closely as possible to who you are as an individual. So, depending on your needs, the personalized UT Health Austin care team we build especially for you may include one or more specialty physicians, as well as a nurse, pharmacist, physical therapist, nutritionist, social worker, or others. Also, we coordinate with your primary care or other community physician to ensure the continuity of your care remains uninterrupted, keeping every valued member of your team up-to-date regarding your situation and needs.

And, working with you, we create an individualized care plan to help guide you, every step of the way, toward your personal health goals.

3. To truly contribute to positive change in our health care system, providers and payors must work together in new, and innovative ways: The history of the American health care system is a nearly uninterrupted record of remarkable advances, rapid change, and evolving attempts to match the increasingly complex and expensive processes and equipment clinicians need with the financial, regulatory and oversight instruments organizations use to keep health care as safe, affordable and accessible as possible. At UT Health Austin, we are working with public and private payor organizations to create new, case rate-based agreements that cover conditions across the entire cycle of care. This collaborative approach allows our clinicians to include important services that are often not a part of comparable bundled payment arrangements, rewarding quality work and potentially helping decrease the total cost of care by focusing on activities that deliver real value for patients and payors.

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Following the work that resulted in the Dell Medical School (constructing a premier physical space, securing the accreditation of a new medical education curriculum, and welcoming our first student classes), our relentless pursuit of excellence moved from the classroom to the care room when our faculty and staff began treating patients as part of our UT Health Austin clinical group practice. In the coming year we will add several new specialty clinics that will allow us to better serve all of our patients’ needs. And in the spirit of discovery that harkens back to The University of Texas at Austin’s foundational ambitions, we will initiate a world-class medical research program in the Health Discovery Building.

Making a positive difference in the lives of our fellow human beings—reducing suffering, easing fear, stimulating communication, and improving the quality of all our lives—is how everyone at UT Health Austin shows how much we care. The three patient stories that follow illustrate the difference our model of care is making in the lives of real people, and each story allows us to discuss in more detail the features that distinguish UT Health Austin as the direct patient care component of our emerging academic medical center.

The last section of this review includes a brief overview of some of the specialty programs and services we will bring to the Austin region in the months and years to come.

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UT Health Austin: Year One

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perational statistics and other performance-based metrics can offer valuable insight into the inner workings of a complex organization. But at UT Health Austin, we believe that the true measure of our work is the positive difference we can make in the lives of those patients who entrust the wellbeing of themselves or their families to our care. As the following stories illustrate, measuring outcomes that really matter to our patients, building interdisciplinary care teams specifically to achieve those outcomes, and working with our payor partners to create a collaborative environment based on transparency and shared goals and purposes are three important ways that UT Health Austin is helping advance the contemporary model of care here at home and, potentially, across the nation.

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UT Health Austin: Year One

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John A vision for the future that started right here at UT Health Austin Situation:

Chronic, treatment-resistant knee pain in both legs renders John all but immobile for years, straining his family relationships, limiting his ability to move, threatening his livelihood.

UTHA Solution: Musculoskeletal Institute clinicians recommend double knee replacement.

Result: Back home, back to the gym, back to work, back to his life.

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23 stairs. 23 painful steps. John walked every day, up and down. He counted each step, every time. Before John received bilateral knee replacement surgery, simple things like getting around his own home, taking his two dogs out for a walk and getting a healthy amount of sleep each night were extremely difficult. Up until very recently, John was living in Galveston, Texas, at his beach home, with those daunting 23 stairs. His outlook on life had gotten to the point where he didn’t know what his future held, wondering if he would ever get relief from his chronic knee pain. He consulted doctor after doctor across different cities and even states, but no one seemed able to help.

“As a patient,” he says, “you rely on your physician to help heal your health problem. But after your situation has not been resolved you think, ‘Okay, I guess I’ll go to someone else who has more expertise, more experience.’ But after the sixth or seventh doctor fails to accurately diagnose the issue, it can start to feel pretty hopeless.”

As John explained, his chronic pain was not only debilitating for him, it was difficult for his family as well. “My family just didn’t know how to help me and it was a very difficult time for us all.”

After years of suffering, he decided to stop working full-time, and he and his wife moved to Austin to be closer to their son and daughter. “My legs hurt so bad that I had to move to a home that was on one level, and since my son and daughter live here in Austin, my wife and I decided to move here too,” he says.

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UT Health Austin: Year One

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John

It wasn’t until a trip to an urgent care one Saturday morning for extreme leg pain that he was referred to see Kevin Bozic, M.D., orthopedic surgeon and Executive Director of the Musculoskeletal Institute at UT Health Austin. John says that after a thorough evaluation, Dr. Bozic determined that his condition was severe enough to warrant a bilateral knee replacement.

“And that’s when my healing process began,” he says.

“I was finally able to find doctors who could correctly diagnose me.”

John’s physical situation—or functional status— prior to surgery was extremely limited. “I was essentially immobile,” he explains, “and it affected me from a business standpoint and a personal standpoint.

I barely left my home, and I had a really negative outlook on life.”

But just five months after his double knee replacement surgery, which took place in July, 2017, John was back to doing the things he loves. He manages his own international oil trading consulting business, goes to the gym to work out, and walks three to four miles every single day. “I feel like a vibrant person in society again,” he says through a broad and genuine smile. “I really feel like a different person now.”

These days, John stays very active and busy keeping up with his two dogs, two cats, his family and his business. He still frequents his home back in Galveston with his wife, and he can now climb those 23 stair steps with ease. “My quality of life is so much better that I couldn’t recommend anyone else for this type of treatment,” he concludes. “Dr. Bozic changed my life.”

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Outcomes

Measuring the Things that Matter Most OBJECTIVE

SUBJECTIVE

VALUE

Scientifically Measurable

Personal but Shared

Care that Makes a Difference

Critical to Medical Professionals

Meaningful to Patients

The Foundation of Our Practice

Guides Quality Standards and Future Improvements

Defines Quality of Life and Degree of Healing

Where Life Science becomes the Science of Life

• Process

- Example: pre-surgery antibiotic administration

• Structural

- Example: median time from ED arrival to clinician contact

• Functional

- Example: HOOS (Hip disability and

Osteoarthritis Outcome Score) and KOOS (Knee disability and Osteoarthritis Outcome Score) as standardized measures

• Process

- Example: comprehensible and convenient billing process

• Structural

- Example: Access to interdisciplinary team at single site

• Functional

- Example: Ability to work in garden

• Perceptual (Emotional)

- Example: Dignified, compassionate encounter and discussion

• 3 Part Process: 1. Outcomes Focus - Create a perspective that utilizes both objective and subjective outcomes to measure health and healing

2. Practice Design - Build a clinical practice designed to

deliver the outcomes that are important to patients

3. Payment Models - Help payors and patients get the most for their health care dollar

How Measuring Outcomes Improves Patient Experience, and Clinical Practice The idea of keeping track of the details of an activity over time is hardly new. Golfers keep score; runners record their times; parents mark the doorframe each year as their children grow. Recording information regularly allows us to understand where we are going by appreciating where we have been.

When it comes to delivering medical care, the complexity of treating many different individuals with many different conditions and situations makes deciding what attributes of a patient’s treatment and recovery most accurately reflect true progress a real challenge. Over time, “outcomes” measures related to activities under a clinician’s control became commonly accepted points of comparison. Did a surgical patient receive the recommended antibiotics at the appropriate time prior to and following a surgery? How many patients who underwent a procedure developed an infection? In an Emergency Department, how long did patients wait, on average, between the time they arrived and when they actually saw a clinician? Today, most hospitals and health systems report certain sets of “process” (or objective practice measures) to the organizations that pay for the care they deliver; and some even publish their results for active and potential patients to see.

At UT Health Austin, we understand the crucial insight outcomes information contributes to our ability to maintain the highest possible standards of care quality today, and as a way to identify and measure ways in which we can make the care we deliver tomorrow even better. That is why, in addition to tracking standardized outcomes measures, our clinicians ask our patients to record information about their goals, expectations and preferences so that we can go beyond following improvement to determine if our patients are really getting better. This combination of “objective” information about things like reliably following accepted best practices, with personal “subjective” patient-reported information, such as what activities (from playing with their grandchildren to climbing stairs or hiking a trail) mean the most to them, is what we at UT Health Austin call delivering value.

As people, we are all different. By determining the personal value various measures can deliver to our patients, UT Health Austin care teams move beyond classifying patients into groups identified by a condition, diagnosis or procedure (back pain, arthritis, knee replacement surgery), and toward an understanding of each patient as a person that helps ensure that every care plan we develop delivers real value in a real person’s life. www.uthealthaustin.org

UT Health Austin: Year One

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Patrice Getting Back to Doing Simple Things — Pain Free Situation: Chronic abdominal pain defies several attempts at a diagnosis and therefore goes untreated.

UTHA Solution: Interdisciplinary team renders diagnosis where others had not.

Result: Surgical intervention alleviates Patrice’s pain, making everyday activities that most people think of as simple easy again, returning her ease of life.

Patrice knew something was wrong when she began having chronic pain in her lower abdomen that got so bad she couldn’t stand long enough to cook dinner for her family, drive out to her son’s basketball game or do her job without extreme discomfort throughout the day.

She consulted two different primary care physicians, but multiple tests and scans were unable to pinpoint the cause of her chronic pain. She was told she needed to lose weight, or that because of several car accidents earlier in her life that her pain was due to trauma, but in her heart, she knew it was something more.

“I’ve been dealing with this pain for almost a year and a half and I knew something was going on other than needing to lose weight, something just wasn’t right,” she says.

During one doctor’s visit she had a painful episode in her abdomen in front of the doctor that took 15 minutes to pass. It was then that her doctor referred her to UT Health Austin’s Women’s Health Institute for a specialist consultation.

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UT Health Austin: Year One

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Patrice In December 2017, Patrice met with Christina Salazar, M.D. who specializes in the management of complex gynecological conditions including endometriosis, chronic pelvic pain, uterine fibroids and ovarian cysts. As part of an interdisciplinary team of health care professionals, Dr. Salazar reviewed Patrice’s situation and the team discussed what they believed would be the appropriate path forward toward a diagnosis and treatment plan.

“When I came here (UT Health Austin), the whole team let me know that their focus was making sure that I would have relief from the pain that had been a part of my life for a really long time,” Patrice explains.

As her examination progressed, Dr. Salazar discovered a mass in her lower abdomen and determined that Patrice was a candidate for a hysterectomy surgery in order to address her chronic pelvic pain.

“Dr. Salazar explained everything to me. She really went into depth about what was going on in my body, what was causing the pain, and she told me she and the team would all do their very best to make sure everything was taken care of—and that’s exactly what they did. Dr. Salazar is like my angel!” says Patrice.

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Patrice had her procedure done in early December.

Several fibroids and cysts were removed, one of which being the size of a grapefruit. After her procedure and full recovery, she was able to return to her everyday life, pain free.

“My experience was wonderful, they (the Women’s Health Institute care team) kept calling to check in on me every other day after my procedure. I had never had an experience like that before with any other doctor,” Patrice says.

Patrice was able to become more active with her four sons and explains that she is happy to be able to do simple things again, like bend over and tie her shoes without pain.

“Everyone at UT Health Austin’s Women’s Health Institute made me feel like I was important, and they just wanted me to be happy and be able to get up and move around easily. I even made of point of showing them that I could bend down, because before the surgery I couldn’t even do that.”

Patrice

Designing and Building a Patient-Centered, Outcomes-Focused Care Team At UT Health Austin, each patient is the focus of an interdisciplinary care team that includes the right combination of skilled medical professionals to address our patients’ concerns today, and to maximize their likelihood of sustained success over time. Based on a concept called the “integrated practice unit,” UT Health Austin care teams are specifically designed to expand our clinicians’ perspective to include all the components of a patient’s life that may affect their care and recovery. Does a patient smoke, and if so, what kind of support might that patient need in order to stop smoking as a way of improving their overall health? Is a patient’s weight a potential issue as a care team prepares that patient to successfully recover from a surgery? What is a patient’s mental state, and is that state a product of their health situation, contributing to the situation, or both?

Depending on a patient’s needs as identified by the patient, and supplemented by pre-visit questionnaires and other information gathered prior to the first encounter, a care team may potentially include one or more physicians and/or surgeons, a nurse practitioner, physical therapist, dietician, psychologist or psychiatrist, a pharmacist, social worker and others. In addition to being organized around each patient as an individual, UT Health Austin care teams also function in an interdisciplinary way, which is different than the multidisciplinary care team structure utilized at many academic medical centers. Though the difference may at first sound relatively modest, it is actually quite important.

Unlike multidisciplinary care, in which medical professionals from different specialties contribute their particular skill to a sequential portion of a patient’s care plan, taking over for a specific purpose or procedure after which the next clinician assumes responsibility for the patient’s progress, interdisciplinary care teams come together to discuss and address a patient’s unique needs as an integrated unit. During these focused discussions, which begin with an initial assessment and continue throughout a patient’s full cycle of care, team members contribute their own expert perspectives, in context, and in real time, making informed connections that generate insight and understanding. And because UT Health Austin care teams work together every day, they use the familiar group dynamic they develop over time to efficiently coordinate every detail of the care plans they create to ensure they always deliver maximum benefit to the patient’s progress. So while a patient may only see one or two members of their team during a particular office visit, every patient always knows that the care they receive is being managed by their entire team.

Finally, because UT Health Austin care teams are committed to caring for each patient as a unique individual, with personal goals, beliefs, preferences and priorities, the care plans they create are designed to ensure that patients will continue improving physically, and emotionally, at home, at work, and wherever their lives may lead. www.uthealthaustin.org

UT Health Austin: Year One

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Eduardo Staying in the Game — Treating a Person, Not an X-Ray Situation: Advanced arthritis in his knee creates pain so severe it threatens the intense, sport-related physical activities that have been a part of Eduardo’s life, all of his life.

UTHA Solution:

While surgery is a viable option, the UT Health Austin Musculoskeletal Institute team creates a customized exercise/ physical therapy and anti-inflammatory medication treatment plan.

Result:

Without surgery, Eduardo achieves relief from his pain in a way that promises to keep him in whatever game he chooses to play for years to come.

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Eduardo

Eduardo, a fit-looking man with bright eyes and a ready smile, will proudly tell you that he is 58 years old. He will, that is, if you can catch up with him which, with a man who walks a minimum of seven miles each working day and plays sports with guys who are generally about half his age five nights a week, is not always an easy task.

“Sports have always been important to me,” he says, sitting behind the desk in his office in the Dell Medical School’s Health Learning Building, where he has been Crew Leader in the Department of Facilities Services for the past two of the 22 years he has been a part of The University of Texas at Austin. “When I was younger, in Mexico before I moved to this country, I played soccer for more than 20 years. But when I came to UT, the guys at the gym invited me to play basketball. I said, ‘Hey, I don’t know anything about basketball,’ but they needed one more man to have enough for a game, so I played.

And I have been playing ever since. Basketball is now my passion. I love it.”

Between taking care of the HLB (or Health Learning Building, where medical students learn), the HTB (or Health Transformation Building, where clinical care is delivered), and the soon to be occupied HDB (or Health Discovery Building, where medical research will be conducted)—“my babies,” as he describes them—and playing basketball three nights, and racket ball two nights a week, Eduardo is in nearly constant motion. Which is why, when arthritis in his left knee started inhibiting his ability to move, it was a serious concern.

“About five years ago I started seeing a doctor,” he recalls, “but the pain kept getting worse. Then, I saw that in the HTB, just across the street, we had new care teams who could look at my knee, so I went to them as a kind of second opinion.”

Karl Koenig, M.D., the Medical Director of UT Health Austin’s Musculoskeletal Institute and a specialist in lower extremity joint replacement surgery, remembers when Eduardo arrived. “An important part of our care model is assessing a patient’s pain and function before they come in,” he says. “Eduardo was very articulate in his patient-reported information, and we could see from his X-rays that he had severe arthritis in his knee. But when you meet him, you can see right away that he is functioning at a very high level. He plays basketball and other sports, a lot. On our team, we always say, ‘We treat patients, not X-Rays,’ so we had an in depth interdisciplinary team discussion that included the mobility goals Eduardo said he wanted to achieve.”

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UT Health Austin: Year One

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Though knee surgery was obviously an option, a potential outcome of a surgery could have meant an end for basketball, which, Eduardo was not ready to accept.

“His goals were very much to continue doing the things that he was doing, just with less pain,” says Dr. Koenig. “Not surprisingly, given his energy level, rather than jumping right into a surgery, Eduardo chose to do an exercise program guided by our physical therapists, along with some anti-inflammatory medication.

It has worked extraordinarily well. Not only did he avoid surgery, but his therapy allows him to continue walking the seven or eight miles he walks every day for work. And he is still playing recreational sports.”

While Dr. Koenig is quick to give Eduardo credit as a model patient who is ready and willing to do the everyday things he needs to do to get the most of the care his UT Health Austin care team provides, he also emphasizes that Eduardo’s care is the product of some very deliberate practice decisions.

“From the very beginning,” he explains, “when we first came together as the Musculoskeletal Institute, we knew we wanted to create an environment in which our clinicians had the time and opportunity to speak to and really understand our patients. The partnerships we have with some of our payors, and many of the arrangements we are in the process of creating, allow us to include service providers on our care teams that you might not find in other academic medical centers. What that means is that we had the time, and the perspective to really get to the heart of what was important to Eduardo, so we were better able to help him achieve the outcomes that mattered most to him.”

Getting up to go, Eduardo enthusiastically agrees, adding, “Dr. Koenig says that I might need surgery later on. Maybe when I’m in my late sixties or early seventies. And even though I am not usually a very patient man, for surgery, I am more than happy to wait.”

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Working Together, Providers and Payors can Impact how Health Care is Delivered As we have seen, the UT Health Austin care model is a continually improving cycle in which our clinicians and health scientists carefully measure personalized patient outcomes information across the entire cycle of care.

We customize the mix of skills on our care teams so we can do the things we know will help us deliver excellent outcomes for all of our patients. Then we analyze our performance and, based on what we learn, we modify our practice to make the experience of our patients even better. This ongoing process ensures that our care teams are always working to identify the activities that deliver real value to patients. And it is the foundation of our third practice priority: working with payors to create closer, more collaborative partnerships between the medical professionals who actually deliver care, and the organizations responsible for paying for the services patients need.

A promising focus of this work concentrates on what we call “case rate” payment contracting. Advancing the concept of bundled payments, in which a health care provider is paid a specified amount for all the services associated with a clinically-defined episode of care, case rate payment agreements are the result of true provider/payor collaboration. Where a typical bundled payment for a knee replacement surgery, for example, will focus on ensuring that the surgery is safely performed at a reasonable cost, the UT Health Austin case rate approach expands the scope of the discussion to include the entire range of options that may help a patient get better. So in UT Health Austin’s case rate approach, getting better at the most reasonable cost, not just performing a given surgery in an economical fashion is the central focus of each care cycle.

With patient outcomes as its primary concern, as opposed to the more traditional fee-for-service model in which payments are made for each step in the care process regardless of the final outcome achieved, by its very nature, UT Health Austin case rates require collaborative analysis by clinicians, statisticians, process experts, and other administrators. Comprehensive options are indexed and quantified so that all the services that will improve a patient’s chances of success are included in the final case rate agreement.

So, if evidence suggests that an elevated body mass index decreases a patient’s ability to perform physical therapy exercises effectively, the services of a dietician to help the patient drop some weight are transformed from a healthy, if elective activity to an important investment in a patient’s total success. Because patients suffering depression, whether as a result of their painful condition, or for other reasons, are often less likely to adhere to a treatment schedule, emotional counseling services can help increase compliance and reduce the expense of avoidable complications. Even things like social worker guidance around accessing such services as affordable transportation or in-home assistance can help a patient navigate the details of their care to maximize the likelihood that they will thrive throughout the process.

It is well understood that the majority of healing happens outside of the confines of a health care facility. Also, emotions and a person’s general outlook contribute to an enthusiasm for health and life. Despite a physician’s best efforts, ultimately it is the patient, through behavior, focus and resolve who can make the greatest difference between a tolerable outcome, and one that is outstanding. By including the skills of health care professionals who can provide direct and supporting services that are often not a part of traditional academic medical center care models, UT Health Austin case rate agreements are working to change the health care conversation for the better.

And, because the model itself is based on coordinating comprehensive services delivered by a collaborative team, the UT Health Austin patient experience is, by design, more interactive, more personalized, and more focused on every aspect of the patient as a unique and complex human being. www.uthealthaustin.org

UT Health Austin: Year One

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Looking Ahead

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Looking Ahead According to numerous sources, including a new “Special Communication” in the Journal of the American Medical Association, health care costs are significantly higher in the United States than in the other 10 highestincome countries in the world (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark). But despite spending 17.8% of our gross domestic product on health care in 2016, Americans have the highest uninsured rate (10% of the population with no health insurance), the highest rate of adult obesity (70.1%), the lowest life expectancy (78.8 years), and the highest rate of infant mortality (5.8 deaths per 1,000 live births) of the countries studied.

A reasonable assumption as to why Americans pay so much for care might be that we simply use more health care services than anyone else. But this does not appear to be the case. U.S. citizens actually utilize medical care at about the same rate as citizens in other countries; we just pay more for everything from medications to administrative overhead. And while it is true that between 2010 and 2016, health spending grew at an average annual rate of 3.6%, which was close to, though still in excess of the economy’s 2.9% overall growth rate, health spending growth increased to 5.3% in early 2018, and most experts expect this trend will continue for at least the next ten years. i

Social Spending as a Percentage of Gross Domestic Product 20

Spending on Health as a % of GDP

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Total health spending Mean

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Government health spending

Private health spending

Mean

Mean

14 12 10 8 6 4 2 0

United States

United Kingdom

Germany

Sweden

France

The Netherlands

Switzerland

Denmark

Canada

Japan

Australia

I. Papanicolas, L.R. Woskie, A.K. Jha. Health Care Spending in the United States and Other High-Income Countries.

JAMA.2018;319(10):1024-1039.

Clearly, there is work to do. Which is why, as an organization, Dell Medical School’s faculty and staff created UT Health Austin as a clinical practice that focuses on outcomes, practice design and collaborative payment models based on value. Our national health system, for all its remarkable strengths and obvious flaws, is the product of decades of work, experimentation and competing priorities. No single intervention will ever deliver the level of systemic improvement necessary to bend the cost curve for the better without risking either care quality or access. And while it can sometimes feel as if the complexity of the problem is overwhelming, at UT Health Austin we remain optimistic about the future because we know that we are addressing today’s issues with both a wealth of experience, and an array of technology-based, information-driven tools, many of which did not exist just five years ago. By focusing our attention on measuring the results that matter most to our patients, empowering interdisciplinary care teams to organize and coordinate their skills specifically to deliver outstanding results, and collaborating with our clinician colleagues and payors to maximize efficiencies and value, we believe that we can help create an array of related improvements that will make a real difference in the health of our community, and a positive contribution to our national discussion.

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UT Health Austin: Year One

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Looking Ahead We are also building something special: a new kind of academic medical center model right here in Austin, Texas.

Traditionally, an academic medical center is an organization that has a strong medical education capability, a substantial medical research program, and a vibrant clinical practice—usually associated with a hospital—through which direct patient care is delivered. UT Health Austin is our clinical practice; the Dell Medical School educates future clinicians while coordinating our translational research initiatives; and our collaborative relationship with the Seton Family of Hospitals, part of Ascension Health, provides both hospital-based medical training opportunities for our students and inpatient care facilities and services for our faculty and staff. So The University of Texas at Austin is home to our nation’s newest, emerging academic medical center, as it is traditionally defined. But there is a feature of our organization that is different, and that, in the truest sense of the word, makes a difference in the lives of the people who entrust themselves and their loved ones to our care.

Austin is a unique and special place. The sense of community, of culture, of being and belonging makes living in this part of the country an experience that is, by its very nature, shared. The University of Texas at Austin is an integral part of Austin’s heritage and social fabric. And our commitment to the city and all the people who live here is an elemental part of everything we have done, and everything we will do. Our commitment to our community is the fourth key component of our academic medical center as we, as educators, researchers and clinicians imagine and define it. It is reflected in the thinking of our faculty, the imagination of our practice designers, and the hands-on work of our residents and fellows. This city, this community, is quite simply a part of who we are, and we are, and will remain, an active part of this community.

David Ring, M.D., PhD Michael Breen, M.D., 21 Henry Guevara, PhD, MPH, FNP-C

Looking Ahead That sense of activity, of connectivity, and of action, is palpable. And, as in so many instances when the right people come together at the right time, in the right place, for the right reasons, the energy, the sense of momentum and excitement that is shared and nurtured by all the people engaged in this work produces a feeling that is, for all of us, very close to magical. It inevitably turns our attention forward, much like the visionaries who established a university far from the coast and far afield, to what’s next, which will include: •

The Texas Center for Pediatric and Congenital Heart Disease With a focus on treating infants, children and adults with congenital heart disease, world renowned heart surgeon, Charles Fraser, Jr., M.D., has come home to his alma mater to build what promises to be a leading pediatric cardiac surgery program in partnership with Dell Children’s Medical Center of Central Texas. As a graduate of The University of Texas at Austin, and now a faculty member of the Dell Medical School, Dr. Fraser will advance the systemic processes of care design, provide outstanding patient care, and inspire and train the next generation of healthcare leaders.

Charles Fraser, Jr., M.D. • The Mulva Clinic for the Neurosciences, Pediatric Neurology Center Led by acclaimed pediatric neurologist, researcher and medical educator, E. Steve Roach, M.D., the Mulva Clinic for the Neurosciences Pediatric Neurology Center will be UT Health Austin’s second partnership with the Dell Children’s Medical Center of Central Texas. The program will focus on the treatment of pediatric neurological issues such as epilepsy, spina bifida, movement disorders, autism, stroke, headaches and brain tumors, and will be a premier center for educating future clinicians and advancing new knowledge through research.

E. Steve Roach, M.D. •

The Mulva Clinic for the Neurosciences, Neurosurgery Center Led by nationally and internationally recognized neurosurgeonscientist, John Kuo, M.D., the Mulva Clinic for the Neurosciences, UT Health Austin Neurosurgery Center will be an unparalleled multidisciplinary program offering comprehensive treatment plans and clinical pathways for patients facing serious acute and chronic brain disorders and conditions.

John Kuo, M.D. In each emerging program, an interdisciplinary team of clinicians, in partnership with other motivated organizations and community physicians, will apply their best, innovative thinking to overcoming the barriers of cost, quality, access and complexity in ways that will help make health and health care a reliable, and sustainable part of everyone’s life. As we have seen, for American medicine to thrive amid the new demands of our information-rich, fastpaced, technology-driven society, it must grow, and it must change. It must be different. In pursuit of that worthy goal, each person who is a part of UT Health Austin, as a responsible steward of our university’s name and traditions, is committed to a personal, accessible, active and caring compassion that will make a real difference in the lives of every member of our great and growing community. i Abutaleb, Y. U.S. healthcare spending to climb 5.3 percent in 2018: agency. Reuters. February 14, 2018. https://www.reuters.com/article/us-usa-healthcare-spending/u-shealthcare-spending-to-climb-5-3-percent-in-2018-agency-idUSKCN1FY2ZD.

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UT Health Austin: Year One

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The activities described in this review were the result of the work of many remarkable educators, scientists, clinicians, administrators and other associated members of The University of Texas at Austin, the Dell Medical School at The University of Texas at Austin, and the UT Health Austin clinical practice. These committed professionals are part of an educational institution and research enterprise organized by clinical institute and department.

The Chairs of our Clinical Departments are: Kevin Bozic, M.D., M.B.A. Chair, Department of Surgery and Perioperative Care Executive Director, Musculoskeletal Institute Professor, Department of Surgery and Perioperative Care R. Nick Bryan, M.D., Ph.D. Chair, Department of Diagnostic Medicine Professor, Department of Diagnostic Medicine S. Gail Eckhardt, M.D., FASCO Associate Dean of Cancer Programs, LIVESTRONG Cancer Institutes Chair, Department of Oncology Director, LIVESTRONG Cancer Institutes Jane C. Edmond, M.D. Chair, Department of Ophthalmology Director, Mitchel and Shannon Wong Eye Institute Professor, Department of Ophthalmology John S. Kuo, M.D., Ph.D. Chair, Department of Neurosurgery Surgical Director, Mulva Clinic for the Neurosciences Professor, Department of Neurosurgery David Paydarfar, M.D. Chair, Department of Neurology Interim Director, Mulva Clinic for the Neurosciences Professor, Department of Neurology Michael Pignone, M.D., MPH Chair, Department of Internal Medicine Stephen Strakowski, M.D. Chair, Department of Psychiatry Professor, Department of Psychiatry William Tierney, M.D. Chair, Department of Population Health Professor, Department of Population Health Professor, Department of Internal Medicine Amy Young, M.D. Chair, Department of Women’s Health Professor, Department of Women’s Health

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UT Health Austin: Year One

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The Goal of the Dell Medical School / UT Health Austin Health Enterprise: Create a forward-thinking academic medical center that provides outstanding care for everyone delivered through a whole-person, interdisciplinary team approach that is focused on the value-based outcomes that matter most to our patients, partners and payors while educating tomorrow’s clinician leaders, increasing the pace of research success, and stimulating positive change in the way medicine is practiced.

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