A Strategic Partnership to Align Inpatient Capacity and Care — Lessons from an Academic Medical Center and a Community Hospital

University of Michigan Health (UMH) and Trinity Health Ann Arbor (THAA), formerly St. Joseph Mercy Hospital, entered into a partnership to improve inpatient access through a collaborative transfer model to (1) utilize capacity at THAA by admitting patients matching available services while preserving established relationships, and (2) preserve high-acuity capacity at UMH by triaging and transferring patients. Rather than consolidating, the model prioritized independence with shared governance. The care delivery unit was named Michigan St. Joes (MSJ) and was located in the THAA site 5 miles away from UMH. The initiative involved dedicated physician hospitalist triagers and care managers embedded in the UMH ED, electronic medical record-based workflows, and patient-facing marketing tools supporting real-time identification, consent, and transfer of patients from UMH to MSJ. Over the 7.5-year life of the initiative, the program transferred more than 14,000 patients, with an average of 159 patient admissions to the unit per month, maintaining an average daily census at the MSJ unit of 23 and about 90% occupancy, and low patient repatriation (0-2 per month; about 1% of monthly transfers). Oversight teams tracked governance, operational, and patient outcomes to ensure quality, safety, and compliance. The goal of preserving high-acuity inpatient capacity at UMH by safely triaging appropriate, lower-complexity medicine patients away from the academic medical center was demonstrated by an average case mix index of 1.19 at MSJ compared with 1.63 among comparable UMH inpatient medicine units during the final 12 months of the program. Although the dedicated MSJ unit ceased operations after 7.5 years, its closure reflected evolving capacity strategies rather than failure of the model. During that time, both organizations expanded their capabilities - THAA realized anticipated growth, while UMH deployed additional capacity initiatives across the continuum of care. Importantly, the collaboration model itself endured, serving as the foundation for subsequent UMH-Trinity Health partnerships and demonstrating that affiliation-based models between independent health systems can cocreate durable, scalable, patient-centered solutions that expand regional access to care while respecting institutional independence.