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Previous Volume 332:407-412 February 9, 1995 Number 6

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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With the rapid growth of managed care and the demise of comprehensive health care reform, most academic medical centers now seem to recognize that they can no longer operate as specialty-driven institutions largely divorced from trends that favor lower costs, less hospitalization, and more primary care. Many centers are responding to these trends by striving to build or join networks of providers in the community. They are greatly expanding their capacity to deliver primary care and teach medical students and residents at ambulatory care training sites. Some centers are also integrating their business and clinical operations, streamlining their management structures, . . . [Full Text of this Article]

Threats to Economic Foundations

Reinventing Structures

New Clinical Organizations

Structures of Governance

Building Networks of Providers

Acquiring Physicians' Practices

Seeking Ties That Bind

Conclusions

References

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