U-M health leaders offer an innovative framework for keeping academic medic...( ong those leaders. The editorial rec...),Health

The editorial recounts how the U-M's health leadership began its course of preventive measures in 1996. At the time, they faced a modest operating deficit, pressure from employers and payers to reduce the average cost for treating a patient, disagreements among hospital and Medical School leaders, constrained funding from the National Institutes of Health due to Congressional cuts, and a lack of facilities where more medical students could be trained as generalists rather than specialists.

But instead of separating the hospital from the rest of the University, or merging with other providers, as other academic medical centers have done in the face of similar challenges, the U-M began to shape its own health care future.

Today, the Health System sees more patients than ever before, maintains a positive financial margin, has reduced its average cost per patient by 20 percent. It also has attracted research support in amounts that make it the ninth largest recipient of NIH funding and help the U-M's research expenditures amount to the largest in the nation.

Among the innovations, improvements and adjustments the authors cite:

Organization

• Unification of the clinical practices of 15 Medical School departments into a single Family Group Practice.
• Integration of the group practice with the University's three hospitals and 32 suburban and rural health centers to focus attention on the bottom line while at the same time stimulating cooperation between departments in patient care and academic research.
• Renaming of the U-M "Medical Center" to the "University of Michigan Health System" to reflect the broad reach of the ambulatory health centers, strategic affiliations with other health care providers and the central role of the Medical School.
• Synergistic use of the Health System's own 190,000-member M-CARE HMO to train residents in managed care and to make investments in medical management, disease management
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