Health care reform is a potential threat to the academic missions of medical schools and academic health centers. But managed care, the source of much of their concern, may also represent a way for medical schools to improve their future academic outcomes. Harvard Medical School and the Harvard Community Health Plan, a large health maintenance organization (HMO) in greater Boston, recently formed the first medical school department to be based in a freestanding HMO. This arrangement is an example of a model that replicates, in a managed care organization, the long-standing and highly successful teaching hospital academic structure in academic medical centers. The authors describe this model in detail, show how the Harvard collaboration works, and explain the benefits each institution saw in creating a joint entity, the rationale for making that new entity an academic department, and the implications for other academic health centers. They conclude that the Harvard experience shows that alliances between medical schools and large HMOs can create vibrant practice settings for teaching and research in academic areas (such as prevention and primary care medicine) that have been relatively neglected in recent times, and that the “teaching HMO” may have the potential to transform academic medicine in the next century just as the teaching hospital transformed it in this century.
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