Practice Notes

With academic-community integration, structure is everything

Times are changing for academic medical centers (AMCs). NIH funding has dropped 25% since 2003, narrow networks are keeping high-cost systems on the outs, and the university brand has an increasingly weaker pull on consumers.

Overall, it's getting harder for AMCs to stay focused on their mission to advance education and research while evolving to support efficient, consumer-driven clinical care. Many are rightfully reacting by doubling down on community partnerships for expanded footprint and relevance. But to integrate in a way that will meaningfully improve finances, quality, and market share, these blended systems need to redesign the underlying structure to accommodate both entities.

Break down faculty siloes

Consider the typical departmental and divisional nature of the faculty practice: The dean oversees the faculty departments, each led by chairs that tend to manage their departments fairly independently of one another. And quite often, there are duplicate infrastructures that could be more efficient if centralized or combined. A siloed approach to governance and management has worked for education and research, but it doesn’t support a scalable, integrated, and value-based care delivery model.

Fully integrated systems are creating a single organizational structure that cuts across and unites both academic departments and the clinical arm in the community, with traits such as:

  • A mixed governing board of academic and community leadership (physicians and executives)
  • A physician-administrator dyad over service lines (or occasionally organized around the market's geographic areas)
  • Opportunities to embed and expand upon the education and research missions within service lines
  • Administrative functions such as revenue cycle, finance, information systems, and HR, that are managed centrally under a chief administrative executive

This integrated governance structure with centralized functions can drive system-wide policies and clinical efficiencies—better positioning the system for value-based care and heightened scrutiny of performance under the MACRA rule.

Learn about how we support AMC integration.

Reorient around the consumer

Historically, patients were used to waiting months for an appointment with a top specialist at an academic hospital. In fact, a long wait time may even have served to confirm a physician's expertise. But today's patients expect shorter waits not only in primary care, but in specialty and sub-specialty care as well.

For AMCs merging or partnering with non-academic systems, the partnership provides a unique opportunity to eliminate burdensome siloes and establish a consumer-focused delivery model across a broad network—and ultimately create a better experience for physicians, staff, and patients. I don't want to understate how challenging this integration can be, both operationally and from a cultural perspective. Still, the results are worth the effort.

My team was working with an academic system in the northeast that had no common standards for patient access across sites. They had to overcome considerable structural and cultural barriers to embed unified policies around access across the faculty and community facilities, and address questions such as:

  • What are the main principles behind access?
  • Can we create a consistent experience through a standardized, best practice model?
  • Are we efficiently managing capacity with the right mix of physicians to APPs and clinical staff?
  • Are there enough primary care physicians to meet market needs, and to help manage risk?
  • Do we need expanded hours to increase access, and how can we manage those additional costs?
  • Are care management procedures tightly in place for smooth patient handoffs and in-network referrals?

Now, with centralized governance across sites and a system-wide vision for access standards, that organization has built an integrated model to deliver convenient, coordinated, and comprehensive services—and is truly advancing a tripartite mission.

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How one academic system built a unified medical group


With over 600 community providers spread across six regions, the University of Maryland wanted to unify their employed enterprise for consistent, cost effective, and coordinated care delivery. From a new governance structure to a standard set of operational protocols, learn about the steps they're taking to get there.