With regard to clinical funding, a very effective instrument is to pool all clinical revenues at the system level (which allows for joint contracting with health plans) and, in return, to distribute funding to hospitals and faculty/physician organizations or departments through a performance-based methodology that rewards productivity, access, quality and safety, and economic efficiency. Similar approaches should be considered for medical training and mission funding. For example, there is a clear trend towards common risk models for mission assistance, which combine discretionary funding with pre-defined metrics or CMA`s financial performance. Specific metrics and objectives will change as organizational priorities change and adapt to the market, but the underlying principles and mechanisms should remain transparent, formula-oriented and performance-oriented. Universities and health systems should also take steps to ensure that there are appropriate common management structures to guide day-to-day functioning between institutions. One strategy is to develop leadership positions with matrix relationships with the health system and with the university or health centre, for example. B senior physicians, who hold two positions at the Health Sciences Centre (for example. B Vice-Chancellor for Clinical Affairs) and the Health System (e.g. B Executive Vice President for Medical Affairs).

Similarly, in the context of functionally integrated AZUHCs, it is customary for scientific department heads to act simultaneously as heads of their respective departments in the hospital or health system. The aim of these dual matrix roles and relationships is to create an environment in which leaders must reconcile the interests of the two organizations with the often competing demands of their collective academic and clinical enterprises. From a health system perspective, outflows into university enterprises account for a significant portion of the operating budget: a recent survey of 55 CMAs showed that funding for health systems for their university or affiliated medical partners represented on average 8.4% of their net patient income. (b) With hundreds of millions of dollars at stake over decades of agreements and large-scale memberships that have continued to be announced in recent years (z.B. Geisinger Health System and Geisinger Commonwealth School of Medicine in Pennsylvania, ProMedica and the University of Toledo in Ohio, Hackensack Meridian Health and Seton Hall University in New Jersey, RWJBarnabas Health and Rutgers University in New Jersey and Banner Health and the University of Arizona) are critical for organizations to critically evaluate their membership agreements and related funding agreements to ensure they are well positioned to advance their partnership goals. As competitive pressure increases, branding and philanthropy will become an increasingly competitive source for some CMAs. Unfortunately, since these elements are often overlooked in the denères, many agreements do not adequately address the range of potential problems that associated companies might face. One such question is how to combine existing brand values (for example. B, the name of universities or health systems and visual identity) in a compelling and differentiated branding strategy representing the CMA while preserving the identity and brand value of its components. From a philanthropic perspective, organizations often face potential conflicts when they follow gifts from grateful patients who have been treated by university faculties in an institution in possession of a health care system. Membership agreements should include clear guidelines and processes to manage these decisions and ensure that efforts are coordinated and that the combined resources of AMC component units are fully exploited.