The University of Michigan can take great pride in its ongoing contributions to solving the critical national problem of disparities in health care, including the plight of the uninsured. U-M President Mary Sue Coleman has taken a national leadership role by chairing the Institute of Medicine's Committee on the Consequences of Uninsurance; the final report of that committee's three years of work is described this issue.

Our attention, however, is not exclusively focused on the national arena. One of the strategic principles that guides the work of the U-M Health System is that of "taking care of our own." We have an obligation to our community and remain committed to improving the health of the population in our primary service area. Academic health centers characteristically have a significant social mission, which includes providing care to the most needy in their area, and we at Michigan embrace that mission.

The Washtenaw Community Health Organization is a prime example of U-M's service to the local community. A public entity formed by the U-M regents and the Washtenaw County commissioners, the WCHO brings together mental health, substance abuse and physical health services for the Medicaid and uninsured populations in the county. By merging resources and care, we are integrating services for vulnerable populations across different treatment settings and improving care for many previously underserved members of the community. The WCHO serves some 15,000 M-CARE Medicaid members, including more than 3,000 individuals with serious mental illness, and provides additional services to the remaining Medicaid and uninsured in the county. In its local efforts, the WCHO administers over $20 million per year in physical health care services and nearly $50 million per year in community mental health services. In its regional affiliation with Lenawee, Monroe and Livingston counties, the WCHO administers an additional $50 million annually in mental health and substance abuse services.

The U-M Health System also is a founding partner in a program that provides health care to the uninsured in Washtenaw County. The Washtenaw Health Plan enrolls 4,000 residents; half are assigned to the U-M where they receive all outpatient and inpatient care. Close coordination occurs with other county agencies, and many of the Washtenaw Health Plan enrollees also receive prescription drug coverage through innovative county programs. Nearly 37,000 people in the county — including 6,500 children — are among the uninsured, a critical community concern.

In Washtenaw County, more than 2,000 individuals access the Homeless Shelter each year, where volunteer U-M physicians provide physical health care. In the coming year, internal medicine residents will begin rotating through the shelter, increasing the amount of care provided.

We are far from solving the social problem of the uninsured and underserved, but we have the commitment we need from health care leaders, providers and the community to work together in tackling this tough problem.

"Taking care of our own" also includes those at the heart of the U-M Health System itself — the employees who, on a daily basis, often in unheralded but heroic fashion, go about the quiet work of sustaining the intricate functions and systems that result in top quality health care for all of our patients. One of my greatest concerns for the future is the maintenance of a highly effective, satisfied and productive workforce, especially in view of current and pending workforce shortage projections. We will do everything we can to retain great employees, retraining them as new knowledge creates new technology and treatments, in order to continue providing expert care with ever-increasing efficiency and cost effectiveness.

The challenges, nationally as well as locally, are profound, but so are our collective resources. I am pleased to live and work in an area where so many people are working together to improve care for everyone who needs it.

Robert P. Kelch (M.D. 1967, Residency 1970)
U-M Executive Vice President for Medical Affairs and CEO, U-M Health System