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Dr.
Cyril Chang, this year's Eminient Faculty Award winner.
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Six mornings a week, Dr. Cyril Chang glides through a fitness
center's swimming pool in Germantown as a prelude to the day's
workload. The exercise routine comprises a cycle of methodical
movements - arm strokes and kicks slice the water's surface
to propel the body forward; the lungs take deep breaths, holding
them until they are greeted by fresh oxygen. Chang's physical
exertion is not only a literal product, but also a reminder
of his primary research as an economist, plunging through
the dense surfaces of numbers into what lies at the heart
of his work: good health.
Chang, a professor of economics at the University of Memphis,
has built a career analyzing health-care issues by placing
them under an economic lens. Somewhere along the way, his
examination of health-care providers' business models began
to deeply affect the way he lived his own life. As a young
adult, Chang kept in decent physical shape through regular
exercise. But 15 years ago - after slacking off for a period
of time - Chang began swimming. He credits his work for jumpstarting
the effort. "Personally, it has made me a lot more health-conscious
than I otherwise would have been," Chang says.
Breathing
life into numbers
On land, few things come as natural as breathing, which occurs
primarily as an unconscious action. Swimming alerts one to
the acts of inhaling and exhaling, demanding a person to significantly
alter his or her breathing patterns. As the body forges a
path through the resistant waters it must learn to synchronize
the movements of the arms, legs and head to adjust to a foreign
rhythm. The persistence that fills the spaces between breaths
is what matters the most.
Chang brings the same combination of discipline and rigor
to his work as a professor, researcher and consultant for
the health-care industry. "He can discern the complexity
of issues," says Gene Cashman, president and CEO of grant-making
outfit LHS Inc. "And the resolutions of those (issues)
are both noteworthy and trusted." Cashman, who also is
a member of the U of M's Board of Visitors, has worked with
Chang for more than 20 years, including engaging the professor
as a consultant when he was CEO at Le Bonheur Children's Medical
Center. He says Chang's sense of integrity and compassion
in recognizing the people behind the business issues give
his analytical skills an emotional resonance. "His character
enables him to speak on matters of principle. Doing the right
thing," Cashman says.
The knotty business of health care has presented Chang with
a number of opportunities to apply economic concepts in an
aim to address and solve problems. After all, as Chang says,
"Economics is sterile unless it is dealt with in a real-world
context." The winner of the 2004 Board of Visitors Eminent
Faculty Award at the University of Memphis, Chang also is
the director of the Methodist Le Bonheur Center for Healthcare
Economics, which is located at the U of M's Fogelman College
of Business and Economics. The center was established with
a $1 million gift from LHS in 2003. Chang, who has been a
professor at the U of M since 1981, is leading the partnership's
mission of optimizing the efficiency of government medical
programs and examining the impact of regional and state trends
in health care.
Tackling
TennCare
One object Chang continues to view through the various angles
of the economic prism is TennCare, the managed health-care
program that enrolls about 1.3 million poor and disabled Tennesseans
and has been plagued by skyrocketing costs. Earlier this year,
Tennessee Gov. Phil Bredesen constructed a plan to overhaul
the program by limiting certain benefits and instituting co-payments.
The changes received approval from the state Senate in May
and were expected to be reviewed by the Centers for Medicare
and Medicaid Services, a federal agency overseeing TennCare,
in July. If the plan receives federal approval, it could save
TennCare $2.4 billion from January 2005 to 2008.
"Fundamentally (Bredesen) has to deal with a very, very
difficult, if not impossible, job," says Chang, who has
written articles on the subject for publications as diverse
as Journal of the American Medical Association and The Commercial
Appeal. Bredesen faces the challenges of satisfying "three
fundamentally incompatible goals of health-care reform"
that the public demands, Chang says. Those things include
the best quality of services, expanding access to services
for everyone and affordable care, according to Chang. "The
trouble is, is it is exceedingly difficult, if not impossible,
to do all three at the same time. Something must give,"
Chang says.
As Bredesen works to save the TennCare system before its
out-of-control costs start to cannibalize the state budget
for other programs, Chang continues to conduct a number of
research projects involving the hotbed of issues surrounding
the program.
One question Chang is exploring: Why do TennCare enrollees
use so many prescription drugs? While the national average
is about 10 prescriptions per year for each person, the state
of Tennessee has an average of 11.5 prescriptions and TennCare
participants tally about 30 prescriptions annually, Chang
says.
"Tennessee is leading the nation in terms of per-capita
utilization of prescription drugs," Chang says. "Tennessee
is not a rich state . . . that can afford that kind of health
care."
A related question is whether the benefits derived from the
prescription drugs justify the steep financial investments
in them. "Are we getting our money's worth? In other
words, has it been worthwhile?" Chang asks. He proposes
that perhaps this much money spent on drugs may not be due
to bad management but because there is actually a significant
need for the drugs. Moreover, perhaps the resources poured
into the drug prescriptions could be helping reduce the amount
of money spent on other health services, Chang says. "So
the high levels of utilization of prescription drugs by itself
is not necessarily a problem," he adds. "It becomes
a problem if the extra money spent is not giving you the extra
benefits."
Chang also is looking for reasons why the level of per-capita
spending of health-care dollars varies from region to region
to determine whether there is an association between the quality
of health care and the amount spent. "Does higher spending
imply higher quality of health care?" Chang asks. He
points out that a recent national study "suggests higher
spending implies lower quality, not higher."
Cost-benefit
analysis of a carpool dad
As varied and ambitious as his projects are, Chang has guided
his career to avoid a zero-sum game scenario, so that his
home life has not been neglected while his work life has thrived.
After receiving his master's in economics in 1972 at then
Memphis State University and his Ph.D in economics at the
University of Virginia, Chang began teaching the subject to
students. In between classes and research Chang found time
for car pool duties when his daughter, Cindy, and son, Andrew,
were attending primary school. "He always kept a good
work and home balance," says Andrew, now an MBA candidate
at UCLA. The Chang household was a busy one. Chang's wife,
Alice, worked at FedEx at the time as a business analyst,
which she recently retired from. In between grading his student's
papers, Chang would assist Andrew and Cindy with their school
projects. Even to this day, Chang still helps edit the school
projects of Cindy, 24, and Andrew, 29. Now it's just at the
master's level (Cindy is pursuing a graduate degree through
Northwestern University's integrated marketing communications
program).
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While
pursuing his master's in economics at then-named Memphis
State University in the early 1970s, Chang met his wife
Alice. Although
both grew up in Taiwan, they didn't meet until they
were living on the other side of the world in Memphis.
"We fell in love with the University, this charming
city on the river and, most importantly with each other,"
said Chang during his acceptance speech for the Board
of Visitors 2004 Eminent Faculty Award.
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Closing
a gap
At the same time, Chang continues to set aside a block of
time each weekend to work on his own projects. One of his
ongoing efforts involves the problematic gap that often exists
between the health-care providers' business models and public
health models. Chang is honing in on challenges facing TennCare
Partners, the mental health and substance abuse component
of the program.
His research data over the past few years has given tangible
proof to assumptions that had been mainly anecdotal in nature,
says Don Voth, executive director of the Memphis and Shelby
County Mental Health Summit, an organization aimed at strengthening
the mental health and substance abuse system in the community.
"I really value his insight and his ability to ask the
right questions," Voth says. "He's very respected
within our community here."
Chang's research points out that in west Tennessee and Shelby
County the majority of TennCare Partners enrollees are African-Americans
who "traditionally - rightly or wrongly - have a distrust
of the medical establishment on mental health matters,"
Chang says. As a result, the clients may be more reluctant
to use the program's services. The extra money from the underutilized
resources of the program ends up being used by other parts
of the state.
The challenge is to find a way to better connect critically
mentally ill individuals with the program. "What you
need is a well-oiled, well-connected, integrated mental health
system that can help those who cannot fend for themselves
and let them into the system," Chang says.
The summit has appealed to Tennessee Department of Mental
Health and Development Disabilities for more equitable distribution,
and it continues to meet with government officials to improve
the existing disparity, Voth says. The next step would be
access to additional money to invest in pilot projects aimed
at connecting clients more effectively with TennCare Partners,
according to Voth.
"The struggle is ongoing," Chang says.
In fact, Chang mentions that he has a meeting later in the
day related to the effort of bringing this issue to the attention
of the state government. This underscores Cashman's comment
on Chang: "His resolve is not just to report on the data,
it's actually to see the reform through."
A carefully planned approach, persistence and patience are
key. Kind of like swimming in choppy waters. Chang already
has the breathing part down. Now, it's just a question of
unknown distance, of an indefinite length of time.
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