What began in 1991 as a philosophy about the future of health care has changed the Medical Center from a superb research hospital into a regional health syste-and it is still growing.
Chancellor for Health Affairs Dr. Ralph Snyderman explained that, in recent years, managed care has begun to play an increasingly large role in health care, and Medical Center officials realized that significant changes were necessary for the hospital to remain competitive.
DUHS is not the only institution to respond to the increased prominence of health maintenance organizations-University of Pennsylvania Health System and Johns Hopkins Health System are two university-affiliated, not-for-profit health systems that have also expanded in the past 20 years.
HMOs promote preventative care, and patients in an HMO system are required to seek initial care with an approved primary physician, who then makes referrals to specialists as necessary.
Larger health systems that encompass more services allow for greater patient choice, explained Frank Sloan, J. Alex McMahon professor of health policy and management.
Moreover, large systems are attractive to HMOs because they are capable of serving many customers and providing a wide range of patient services.
"Groups are looking to contract with networks of systems, not individuals," Sloan said. "You can't compete if you have only one hospital."
Dr. William Kelley, CEO of the University of Pennsylvania Health System and Dean of the School of Medicine agreed, explaining the University of Pennsylvania Health System's recent expansion by saying, "We want to be big enough to be the best."
DUHS' current network of care places it in a competitive position.
The system has managed Person County Memorial Hospital since Oct. 1997 and recently beat out four competitors to win the right to lease Durham Regional Hospital. Additionally, DUHS announced last week the purchase of Raleigh Community Hospital.
"What we're trying to become is a regional, integrated health system providing a full continuum of health services," Snyderman said.
To that end, DUHS has also expanded its network of services, growing to include aspects as diverse as health education, hospice care and joint-ownership of WellPath, a Durham-based HMO.
During the past year, preliminary partnerships have also been struck with Triangle Hospice, St. Joseph of the Pines in Pinehurst, N.C. and the United Methodist Retirement Homes, which operates four retirement communities. Through two additional programs, Duke University Affiliated Physicians and Community Private Diagnostic Clinics, DUHS now also includes some local doctors.
"We've just kept on better defining and implementing the expansion of the health system," Snyderman said, adding that recent institutional changes have aided the process.
Among these changes are revised management procedures adopted early this year. Now, plans for DUHS must only be approved by the Medical Center's Board of Trustees instead of also clearing the University's Board of Trustees. This change, passed by the University's Board of Trustees at their Feb. 27 meeting, streamlined the decision making process.
Snyderman described the Medical Center's new Board as "quasi-independent," explaining that DUHS is owned by the University and a majority of members of the new board is drawn from the UniversityPis Board of Trustees. The split also allows representatives from Durham Regional to serve on the board, and Snyderman said he anticipates a position for someone familiar with the needs of Wake County, the location of Raleigh Community Hospital.
When asked to speculate about future expansion, he estimated that the health system has expanded to about 40 percent of its eventual size.
"We're not trying to encompass the entire south east or the world," Snyderman said, explaining that DUHS is focusing on the 22-county area surrounding Durham and portions of neighboring states.
DUHS's expansion into the community coincides with the University's goal of improving its relationship with Durham. Snyderman explained that the University's main emphasis is on the area surrounding campus, an area that includes Durham Regional Hospital. This heightened consciousness led to the creation of the West End Project, an initiative that Snyderman said looks at the health care needs and health education of the Durham area.
Sloan said that DUHS's expansion helps it maintain the educational goals of the University. He explained that for such university-affiliated health systems education is not a profit winning proposition, therefore, "to the extent that this system makes profit, the money goes to improving research [and education]."
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