How Dell Med School Hopes to Transform Health Care

By Andrew Roush in Features, Sept | Oct 2017, Special on September 1, 2017 at 9:24 am | 1 Comment

Now with the Dell Med School’s second class of future physicians, brand new buildings, and actual living, breathing patients, there are a few early signs of success. 

The situation was dire, they were told. In 2012, as Austinites headed to the polls, they heard consistent arguments that the future of health care in Central Texas was in their hands.

UT administrators, health care providers, and politicians said something must be done to ensure a sustainable system of care. There was a looming shortage of 700 doctors, an aging population was putting a massive strain on the existing system, and University Medical Center Brackenridge was decrepit and unfit for the 21st century. A new solution was needed, and while many local powerbrokers supported such underwriting, it was up to the public to determine the direction. Perhaps they could make Austin the healthiest city in America, but the investment would require their money.

Now, the results of that decision are taking root in Central Austin, just south of the UT Austin campus, in the form of the Dell Medical School, a brand-new hospital, and an extensive partnership meant to keep every person in Travis County healthy.

The concerns about health care in America today run all the way from the U.S. Congress, still in the midst of a decade-long battle over health care, to medical schools, where doctors are trained. Older teaching institutions are saddled with constituencies and interests that emerged through time, rather than through a clear starting vision. The Dell Medical School, UT’s most ambitious venture in decades—and possibly ever—is the opposite of the old model. It was pitched to Travis County voters as an investment in better health for everyone in the Austin area. It was planned as a hub for innovation. In July, Gov. Greg Abbott announced that Merck, the maker of drugs like Singulair and Gardasil, will bring a technology center to the new health business district mushrooming around the school, thanks to a $6 million grant from the state’s enterprise fund. The move, which the company says will create more than 600 high-paying jobs in Austin, is directly tied to the ability to partner with the medical school. Austin state senator Kirk Watson—himself a vital player in the creation of the school and the Medical District—hailed the announcement, and tweeted that Dell was a major reason for the investment. New partnerships are showing the breadth of the school’s vision, from an affiliation with the nonprofit ridesharing service RideAustin to get low-income patients to their appointments to The Lady Bird Johnson Wildflower Center providing a rooftop park of wildflowers, succulents, and native plants.

And as the second class of white coats—60 percent of whom are women, and 20 percent are from minority groups that are underrepresented in medicine—enters a suite of new buildings near the Frank Erwin Center this fall, researchers, clinicians, students, and administrators are diving into their founding mission: to transform health care as we know it.

That transformation is starting to show early signs of success, as wait times shrink, students focus on clinical practice, and new ideas  percolate into the community. In the school’s pitch to the Travis County taxpayers who made it possible, in the pristine new halls of its still new–smelling buildings, and in conversations with the inaugural team of administrators and students, the Dell Medical School’s ambitious mission is clear: to craft a new kind of medical education, one focused on treating patients rather than diseases, and one enterprising enough to change the way other medical schools are structured in the future.

On Nov. 6, 2012, voters in Travis County passed Central Health Proposition 1, a considerable increase in property taxes meant to launch and support the new, community-centered medical school, as well as improve trauma care. The ballot measure was put forward through Central Health, a county-wide public health district designed to support doctor visits and ongoing care for the most vulnerable residents of the regions: the poor and uninsured.

It was an unprecedented move. For the first time, a Texas community had voted to raise its own taxes—the health care tax went up 63 percent—in order to catalyze a partnership between Seton, the nonprofit Catholic hospital system, Central Health, and the university. With the passage of the proposition, Seton agreed to build a new teaching hospital, the Dell Seton Medical Center at The University of Texas at Austin, meant to replace the aging Brackenridge, just across the street from the new site. The UT regents chipped in an additional $25 million and $5 million each year of endowment money to keep equipment up-to-date. Central Health would use the resources of the new medical school to help improve clinics around the county, and secure millions in matching federal dollars, contingent on measurable improvements in local health.

Then-president of the university, Bill Powers, called it a historic night. Greg Fenves, then UT’s top academic officer, set about finding a dean to lead the new school—someone who was willing to build a totally new model for medical education and general health care, with an emphasis on outcomes for the patient and a business model that relied on those outcomes, rather than the number of procedures undertaken. Fenves, who now serves as the president of UT, pegged Clay Johnston for the deanship in 2014 and gave him free reign to articulate a big, bold vision. Johnston, who looks something like how you might imagine Troy Aikman’s little brother, set to work with vigor, pulling together all the things that would coalesce into a new kind of medical education: curriculum, administrators, teachers, class schedules, partnerships with other parts of the vast UT corpus academic, partnerships with the Seton Healthcare System, Central Health, and of course, students. Choosing the right people—people who believed health care can be better, and who want to make it so—is still a critical part of the school’s success.

“I came here because of the vision,” says Amy Young, chair of women’s health. “[Johnston] sets a vision and a tone that encourages thinking about things differently—not just differently,” she adds, “but better.”

The effects of that vote and the subsequent flurry of hiring, building, planning, and teaching are already rippling into the community, even as the school welcomes its second class of aspiring doctors.

“We’re already seeing the tangible benefits of having a partnership with the medical school and the teaching hospital,” Mike Geeslin, the president and CEO of Central Health says. “We currently have 150 Dell Medical School residents rotating through five of our community care clinics in Austin, and there are 170 residents primarily based at the new hospital.” Looking forward, Geeslin sees more than just an increase in doctors. He envisions a health care system that uses technology to cleverly defuse inherent problems in the current care landscape. People with the flu, for example, should be able to talk to their doctor without hopping in the car, driving around town, lurking in a waiting room for 40 minutes (the national average), and wearing themselves down while spreading germs. Teams of doctors, all focused on the same patient, should be able to work collaboratively to build holistic solutions for the sick.

“As the medical school matures and they begin bringing clinical services online, that will be important to Central Health, not only in terms of providing care for patients, but helping us redesign health care systems, whether it be in a brick-and-mortar facility, or some other delivery system,” Geeslin says.

At the time of the vote, Austin was the second-largest city in the U.S. without a medical school. The other was San Jose, California, the rich, ever-growing technology center at the southern tip of San Francisco Bay. Proponents of Austin’s proposition imagined a knock-on effect from the school: new business and startups in biotech, and a growing sense that the Silicon Hills could beat Silicon Valley at the intersection of health care and the free market. Across the bay from San Jose, neurologist Johnston watched the proposition pass while in his position as vice chancellor for research at the University of California, San Francisco Medical Center.

Johnston spends at least part of his days in a sparse, modern office on the top floor of the Health Learning Building, which sits on 15th and Red River, smack-dab in the middle of what’s beginning to be called the Health or Medical District. The Austin skyline, an ever-changing grow-your-own-crystal kit of new buildings is visible through windows that cover the room’s south wall. Austin is a natural fit for the first new medical school built at a major American research university in nearly 50 years. There is a wealth of resources to draw on, and UT offers renowned colleges with which to collaborate. But Johnston believes that resources alone won’t make a med school stand out. To usher in the kind of change Johnston and his colleagues see as crucial, you need innovation. You need moonshot thinking.

“The kind of people we’re choosing are good for the community,” Johnston says, peering out the window wall in his office. They are leaders with passion, a sense of creativity, and life experience. Few come straight out of undergraduate programs, as Dell values candidates with real-world experience. “And they’re great people,” he adds. “Change-the-world kind of people.”

“I came for pretty much the same reason that all my colleagues came,” says Kevin Bozic, an orthopedic surgeon and Dell’s chair of surgery. “We were frustrated with the lack of progress in evolving the delivery system toward one that incentivizes value, which is defined as outcomes that matter to patients.”

Most of those colleagues, Bozic says, came from successful, traditional academic medical centers. The job of such centers is to provide vital support for what Bozic calls the “sickest of the sick”—a catch-all safety net for many cities. The problem is that most people in those communities don’t directly benefit from the kind of indigent care medical schools provide.

“Since we have a different funding model,” he says, “we really take seriously the idea that our mission is to improve the health of all people in Travis County.”

Helping 100 percent of the people in Travis County, rather than only 3 or 5 percent of the worst off, requires a fresh perspective. Young calls it an exciting time to think without constraints.

“The current educational theory is: What’s a better way of teaching this, and what’s a better way of assessing it?” Young says. As a contemporary program and curriculum is developed, so too is a new generation of doctors, trained in a broad vision for complete, efficient medical care. Classrooms are flipped, with students preparing before class sessions, and using the time with their instructor to interact, rather than be lectured.

“It’s easier to create something new than improve something old,” Young says.

The American Medical Association is intrigued, and has already included Dell in grants meant for the most innovative medical schools. AMA medical education head Susan Skochelak described the new school as “very special” to the Austin American-Statesman.

One of the Dell School’s flagship forays into innovative thinking is already bearing fruit. In late 2015, the school christened its first integrated practice unit (IPU), a team of specialists dedicated to a specific health issue—in this case, osteoarthritis—focused on solutions for each patient, without the kind of ping-ponging between specialists that’s common today and difficult for low-income patients. The Design Institute for Health, a joint venture between the medical school and the College of Fine Arts, is helping build clinical spaces meant to improve the patient experience, with big goals, like eliminating waiting rooms. The Value Institute for Health and Care is providing training and research based on the school’s new vision for the medical business: charging for improved health, rather than per doctor visit, procedure, or length of hospital stay. By emphasizing a fee-for-outcomes model, researchers and clinicians are incentivizing innovation, and hoping to reduce repeated MRIs, consultations, and surgeries.

“If you wake up with a headache,” Bozic says, “you don’t go see a neurosurgeon. For some reason, the system has evolved so that if you have knee pain, you go see an orthopedic surgeon. Probably not the best use of the orthopedic surgeon’s time or yours.” That’s why Dell’s first IPU is designed to bring together a team of care providers all working together—doctors, physical therapists, behavioral health specialists, nutritionists, pharmacists—in one place. “All of the members of that team are set up to address the needs of the patient.” Orthopedic care for Austin’s low-income and uninsured population, considered a critical need in the Austin area, was the first experiment in Dell Med’s new model. The wait time for this population to receive orthopedic specialty care in Austin has been slashed from over a year to under a month.

“The outcomes are substantially better than they were previously,” Johnston says of the people served by this project, “and the cost is less.”

A medical school doesn’t start all at once. The pieces come together over months and years and the results spread out over generations. The moment that made everything real for Johnston, that gave him a sense of a true kickoff for the school, was the white coat ceremony, a rite of passage marking the beginning of a student’s medical education. Standing onstage in the 1,000-seat LBJ Library auditorium, President Fenves said it was a day as memorable as the day in 1883 when UT welcomed its first 220 students. Computer mogul and namesake Michael Dell told the fresh-faced students to take risks. Senator Watson told them to do good.

When it was Johnston’s turn at the mic, his message was simple. “You have a very deep responsibility to pay back to the individuals, families in society,” Johnston said. “That is the way your careers will be the most satisfying.”

Photo by Charles Quinn. Illustration by Daniel Bejar.