Maintaining the Integrity of the Missions: Academic Medicine Participation in Health Care Consolidation

Below is an edited excerpt of a recent guide for academic medical centers authored by Manatt Health. Click for the full guide.

Market consolidation is reshaping the health care delivery system. Giant payers rule the insurance market. Health system colossuses are scaling up—and repositioning themselves as research and education innovators. Academic medical centers (AMCs) are evolving to keep pace, growing their clinical scale and incorporating community-based practices and services within their identities. But their success as academic institutions will depend also on whether clinical growth supports or erodes their education and research programs and strengthens or weakens their faculty identity.  outlines the emerging pressures, strategic responses from leading AMCs, and imperatives for CEOs and deans seeking to maintain the integrity of the missions. When done right, scaling the clinical enterprise multiplies academic impact.

Scale enables academic health systems to realize the full promise of their mission: expanding access to clinical trials, increasing training capacity for the next generation of health professionals, launching new medical schools, and tackling entrenched health disparities through community-based innovation.

Expanded Clinical Research Networks: A broader network will facilitate multisite studies, enhance patient recruitment, and provide access to uniquely rich clinical data. Most importantly, it makes clinical trials available to large portions of the population that previously had geographically limited access. The University of California Health’s (CDI2), for example, leverages clinical data from across UC’s five AMCs. Mass General Brigham’s large, integrated network has allowed for population health studies across diverse demographics, strengthening research impact. University Hospitals of Cleveland has established itself as a highly successful, health policy center focused on the needs of NE Ohio—and is designing interventions to improve health in the region. Johns Hopkins has matured as a clinical research network for its three hospitals in the national capital region (Suburban, Sibley, and Howard County), and formed a dedicated research office to support multisite trials, including Phase 1.

More Rotational and Educational Sites: The scarcity of clerkship opportunities exacerbates shortages in primary care and other specialties. Acquired or affiliated community hospitals provide diverse training sites for undergraduate medical education and graduate medical education (GME), the opportunity to start or expand residency programs, and expand fellowships. They also provide venues for expanded nurse practitioner and physician assistant programs, a growing need. The Wake Forest University School of Medicine is now leading the evolution of Advocate Health as an “academic Learning Health System” with 11 teaching hospitals. Residents throughout the system will be able to tailor their clinical training experience to what is best for their particular interest. Establishing and expanding clinical training in traditionally underserved geographies has the added benefit of increasing the likelihood that physicians entering practice will view those areas as potential places to stay.

Enhanced Medical Education: Enhancing medical education with new schools, regional campuses, and expanded offerings strengthens the fabric of health care—but it’s a costly and challenging endeavor. The largest health systems have the clinical scale and financial resources to undertake new development. Atrium Health/Wake Forest SOM will soon open a new campus in Charlotte—bringing a four-year school to a large city that has not yet had one. Hackensack Meridian Health in 2015 started a medical school with Seton University—and subsequently brought it fully into the health system. Kaiser Permanente opened its new Bernard J. Tyson School of Medicine in 2020, differentiated by providing early clinical exposure and emphasis on health systems science. The Northwell/Hofstra Zucker School of Medicine is known for early clinical immersion and has benefited from the immense growth of the clinical enterprise now known as Northwell Health. In the recent March 2025 Match Day, approximately 25% of the graduating class matched into Northwell Health.

New Scope to Address Health Disparities: Larger systems have the reach to address health disparities in underserved areas and to become partners in engaging communities to improve health. The greater scale of a system can support sustainable funding and long-term commitment to community engagement efforts. For example, in early 2024, UH opened its , which aligns its delivery system with place-based policy solutions and interventions. The HFH-Michigan State partnership will open a major new research facility in downtown Detroit in 2027, with a primary purpose to research and then close, in coordination with the health system, disparities in health care outcomes.

These extensive benefits—which characterize academic health systems—are made possible due to the enhanced financial capacity for investment that has resulted from scale.

The future of academic medicine will rest significantly with the actions taken by the emerging leaders of academic health systems. Leadership imperatives required to maintain the integrity of the missions include:

As AMCs themselves act as system-builders, the imperative of scale must be realized—but not at the sacrifice of identity. Preserving and enhancing the missions and re-committing to the core values that make academic medicine unique can transform risk into generative opportunity.

Editor’s note: These insights originated with a lively panel discussion at AAMC Learn Serve Lead November 2024 titled “Academic Medicine and Market Consolidation”.  The panelists were Julie Freischlag, CEO and chief academic officer of Atrium Health Wake Forest Baptist, chief academic officer and executive vice president of Advocate Health, and executive vice president for health affairs at Wake Forest University and Chair-elect, AAMC Board of Directors; and Tom Enders, Senior Managing Director, Manatt Health Strategies.  The panel was moderated by Atul Grover, Executive Director, AAMC Research and Action Institute. To read the full briefing note, click .