THE TEACHING HMO - A NEW ACADEMIC PARTNER

Health care reform is a potential threat to the academic missions of m edical schools and academic health centers. But managed care, the sour ce of much of their concern, may also represent a way for medical scho ols to improve their future academic outcomes. Harvard Medical School and the Harvard Community Health Plan, a large health maintenance orga nization (HMO) in greater Boston, recently formed the first medical sc hool 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 s tructure in academic medical centers. The authors describe this model in detail, show how the Harvard collaboration works, and explain the b enefits each institution saw in creating a joint entity, the rationale for making that new entity an academic department, and the implicatio ns for other academic health centers. They conclude that the Harvard e xperience shows that alliances between medical schools and large HMOs can create vibrant practice settings for teaching and research in acad emic areas (such as prevention and primary care medicine) that have be en relatively neglected in recent times, and that the ''teaching HMO'' may have the potential to transform academic medicine in the next cen tury just as the teaching hospital transformed it in this century.