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Aligning Delivery System and Training Missions in Academic Medical Centers to Promote High-Value Care

Gupta, Reshma, MD, MSHPM; Sehgal, Niraj, MD, MPH; Arora, Vineet M., MD, MAPP

doi: 10.1097/ACM.0000000000002573
Perspective: PDF Only

Academic medical centers (AMCs) are transforming to improve their care delivery and learning environments so that they build a culture that fosters high-value care. However, AMCs struggle to create learning environments where trainees are part of the reason for institutional success and their initiatives have high impact and are sustainable. The authors believe that AMCs can reach these goals if they co-develop strategic priorities and provide infrastructure to support alignment between the missions of health delivery systems and graduate medical education (GME).

They outline four steps for AMCs and policymakers to create an infrastructure that supports this alignment to deliver value-based care. First, AMCs can align strategic priorities between delivery systems and educators to achieve high-impact outcomes by creating a common understanding of prioritization drivers and increasing motivators for alignment. Second, AMCs can support alignment with data from multiple sources that are reliable, valid, and actionable for trainees. Third, resident initiatives can create sustained impact by linking trainees to the institutional staff and infrastructure supporting value improvement efforts. Fourth, incentive payment programs through medical education could augment current system incentives to propel further alignment between education and delivery systems. The authors support their recommendations with concrete examples from emerging models created by GME and health delivery system leaders at AMCs across the country.

R. Gupta is medical director, quality and value improvement, UCLA Health; assistant professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California; and director, Evaluation and Outreach, Teaching Value in Healthcare Learning Network, Costs of Care, Boston, Massachusetts.

N. Sehgal is professor, Department of Medicine, University of California, San Francisco, School of Medicine (UCSF), and vice president and chief quality officer, UCSF Health, San Francisco, California.

V. Arora is professor, Department of Medicine, and director, GME clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois; and director, educational initiatives, Costs of Care, Boston, Massachusetts.

Acknowledgements: The authors wish to thank the education and health system leaders at the institutions described in the manuscript.

Funding/Support: None reported.

Other disclosures: Dr. Reshma Gupta is the medical director for quality and value at UCLA Health and the director of evaluation and outreach at Costs of Care, Boston, Massachusetts. Dr. Sehgal is vice president and chief quality officer at UCSF Health. Dr. Arora is director of GME clinical learning environment innovation and the director of educational initiatives at Costs of Care, receives royalties from McGraw Hill, serves on the board of directors for the American Board of Internal Medicine, and received a grant from the Accreditation Council for Graduate Medical Education.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Reshma Gupta, Medical Director of Quality and Value Improvement, UCLA Health, Assistant Professor, Division of General Internal Medicine and Health Services Research, 10945 Le Conte Ave, Suite 1401, Los Angeles, CA 90095; telephone: (510) 847-6226; e-mail:; Twitter: @ReshmaGuptaMD.

© 2019 by the Association of American Medical Colleges