Alec Rosenberg, UC Newsroom
The University of California Board of Regents will discuss the possibility of creating a UC Health oversight board to enhance governance and help sustain the continued growth of UC’s academic medical centers.
UC’s five academic medical centers — Davis, Irvine, Los Angeles, San Diego and San Francisco — face increasing financial pressure amid a competitive, rapidly changing health care environment.
UC Health has taken steps to increase coordination and stay ahead of the curve, such as systemwide initiatives to reduce costs and improve quality at UC medical centers. Still, UC Health leaders are concerned that additional efforts might be needed. In March, regents contracted with RAND Health to help evaluate options that could ensure UC Health remains nimble enough to stay competitive in the health care marketplace while maintaining continued excellence in patient care, research and education.
The regents Committee on Health Services will discuss the RAND report July 22 but is not expected to take any action before September.
“We are looking forward to discussing this with regents, as we work together on steps to ensure the continued growth and sustainability of UC academic medical centers,” said Dr. John Stobo, UC Health executive vice president.
RAND assessed four options for how UC Health’s governance structure could be better equipped to respond quickly to the changing health care environment and to capitalize on the scale of the UC Health system. They include:
- Option 1, status quo with implementation of best practices: Maintain the existing governance structure while providing onboarding and ongoing training for regental board members, identifying and using a standard set of performance metrics, and periodic evaluations of the governance system.
- Option 2, UC Health system advisory board without delegated authority: Create an advisory board to the regental Committee on Health Services, with the committee’s chair and vice chair, UC Health executive vice president, CEOs and chancellors of each of the five medical center campuses, and five external experts in health care and related fields. The University of Kentucky and University of Washington have similar health care advisory boards. They provide advice and guidance to those with decision-making authority.
- Option 3, UC Health oversight board with delegated authority: This option adopts all the features of the proposed UC Health system advisory board but also formally delegates some decision-making authority to a newly created UC Health oversight board. The regents and their Committee on Health Services would retain ultimate authority over UC Health but would empower the oversight board to make certain decisions on their behalf and under their guidance. The University of Connecticut has a similar model.
- Option 4, spin off UC Health as a separate entity: In this option, at least some UC academic medical centers would become legally separate from the rest of the university, with separate governance structures. The report notes that this option would require a significant amount of negotiation and has a high risk of failure. It is highly unlikely, at least at this time, that the context and environment at UC Health are appropriate, or the problems significantly large, to warrant this solution, according to RAND.
RAND assessed these options using seven criteria:
- timeliness and efficiency of decision-making;
- expertise;
- ability to provide strategic guidance;
- ability to take advantage of system-level efficiencies;
- ability to maintain alignment across the three missions of patient care, research and education;
- responsiveness to local campus conditions; and
- feasibility.
Based on those seven criteria, RAND determined that improvements could be made in the UC Health governance structure, and the most-preferred option is the third one: creation of an oversight board with delegated authority. It has the advantages of increased agility, health care-specific expertise, and ensures a balance between cross-campus system issues that takes into account the need for individual medical centers to align with campus activities and local market conditions.
RAND’s next-best option is the second one: establishment of an advisory board. It provides some of the same benefits as the third option, though without the same degree of autonomy and speed in decision-making.
