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

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. This brief 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.

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.

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