Hospital Pharmacy - June 2019 - 170

823735
research-article2019

HPXXXX10.1177/0018578718823735Hospital PharmacyErstad et al

Director's Forum

Integration of an Academic Medical
Center and a Large Health System:
Implications for Pharmacy

Hospital Pharmacy
2019, Vol. 54(3) 170-174
© The Author(s) 2019
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https://doi.org/10.1177/0018578718823735
DOI: 10.1177/0018578718823735
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Brian L. Erstad1, Tina Aramaki2, and Kurt Weibel3

Abstract
Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in
the process of undergoing integration. Method: This report describes the merger of an academic medical center and
large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college
of pharmacy and a health system's pharmacy services. Results: Overarching pharmacy issues to consider include having
an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one
high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system
involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research,
and clinical service activities, having focused discussions between college and health system pharmacy administrators
on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical
faculty members affected by the merger. Conclusion: The integration of a college of pharmacy and a large health system
during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and
post-merger discussions between college and health system pharmacy administrators that include a strategic planning
component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial
collaboration.
Keywords
clinical services, pharmacists, education, management, residency training, programs, schools of pharmacy

Introduction
Academic medical centers or teaching hospitals have teaching and research responsibilities that have cost implications
beyond the patient care mission shared with all hospitals. In
addition, academic medical centers care for a disproportionate share of patients with no ability to pay, patients with
capped reimbursements, and patients receiving services that
often lead to financial loss.1 Academic medical centers may
need health system partners to navigate the changing paradigm of health care delivery. This has led some academic
medical centers to merge with larger health systems to maintain financial viability to support their missions of patient
care, teaching, and scholarship. Such mergers are challenging
for the academic partner that is attempting to preserve its
teaching and research missions, particularly through cofunded clinical faculty positions, and for the health system
that is attempting to provide high quality care in an increasingly competitive market focused on cost containment.2,3 The
literature is replete with mergers that have failed and lessons
learned from these failures including the need for careful execution and planning by a board that is focused on the new

entity resulting from the merger, appreciation for cultural differences and related impediments, limitations of economies
of scale and associated savings, and lack of buy-in by key
stakeholders.4-6 Furthermore, the effects of mergers on quality
of care and patient mortality require substantiation.7 This
report describes the merger of an academic medical center
and large health system with a focus on the implications of
the merger for pharmacy from the perspectives of both a college of pharmacy and a health system's pharmacy services.
The objective is that it will provide some lessons learned for
other colleges of pharmacy and health systems contemplating
or undergoing similar integration.

1

University of Arizona, Tucson, USA
Banner-University Medical Center Phoenix, AZ, USA
3
Banner-University Medical Center Tucson, AZ, USA
2

Corresponding Author:
Brian L. Erstad, Professor and Head, Department of Pharmacy Practice
& Science, College of Pharmacy, University of Arizona, 1295 N. Martin
Avenue, PO Box 210202, Tucson, AZ 85721, USA.
Email: erstad@pharmacy.arizona.edu
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