title: Disease burden in the managed care population at an academic medical center: the effect of adding local partners.
abstract: OBJECTIVE
  Academic medical centers (AMCs) have traditionally cared for the most severely ill patients. AMCs' effort to meet the challenges of managed care contracts may be nullified by adverse selection unless payment mechanisms adequately consider the health risk of the AMC's managed care population. The authors compared the disease burden between the University of Michigan Health System (UMHS) and its community competitors and assessed the effect of adding local primary care partners through strategic outsourcing on these differences in disease burden.
  
  
  METHODS
  This is a population-based study from one managed care plan in Michigan. The study population was commercial members (n = 127, 892) enrolled in the plan for the entire 12 months of 2001. The authors derived several morbidity measures from age and sex, Adjusted Clinical Groups, and Aggregated Diagnosis Groups using administrative data.
  
  
  RESULTS
  Compared to community groups, the UMHS consistently had a higher disease burden, while the nonacademic groups as a whole had more young members with acute conditions. After the UMHS partnered with two local primary care practice groups in their area, this AMC-local partner group had an equal or lower disease burden than the remainder of the community groups that experienced a slightly higher proportion of members with multiple medical conditions.
  
  
  CONCLUSIONS
  The higher disease burden borne by AMCs is a complex phenomenon. Without local partners, the UMHS did experience higher disease burden, although the degree depends on the measurement of morbidity. Partnering with carefully selected local primary care groups may ameliorate the AMC's disproportionate disease burden.
authors.affiliation: University of Michigan Medical School, Ann Arbor, USA. jbilli@umich.edu
authors.forename: John E
authors.initials: JE
authors.lastname: Billi
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Pai
authors.forename: Edward D
authors.initials: ED
authors.lastname: Rothman
authors.forename: David A
authors.initials: DA
authors.lastname: Spahlinger
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003953:Diagnosis-Related Groups; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008824:Michigan; D008875:Middle Aged; D017678:Sex Distribution