Seven critical features are listed below and should be included in all accession agreements, either as amendments to existing agreements or as part of new final agreements. These points, regardless of organizational structure, will be relevant to all CMAs, but are best applicable in cases where the university and the health system are not integrated into the company as a whole. The structure of the practice of faculty groups (FGP) and other medical organizations employed or affiliated (as explained in more detail in this article) also has an influence. Health systems and universities seem to be constantly at odds, stuck in ongoing negotiations despite leaving long-term association agreements. Whether it`s faculty recruitment packages, acquired services and program support agreements, compensation for graduate medical training, or the countless other problems that university medical centers (CMAs) have to address, there tends to be trapped in a transaction characterized by both ad hoc agreement. A modern and well-structured agreement between the health system and the university is an agreement that clearly defines the value of the partnership, defines important obligations and responsibilities, and meets the needs of each party (as shown in the figure below), while enabling the implementation of common strategic priorities. Crosswalk between the AAMC UCTA agreement and the LCME accreditation standards (academic year 2019-2020 – 2020-2021) (PDF) Organizations should move from a primary transaction relationship (often characterized by an overwhelming number of nonconsistible contractual agreements) to a more comprehensive definition, a more performance-based payment mechanism, with common risk/return and clearly identified funding opportunities for clinical and academic activities. With regard to clinical funding, a very effective instrument is to pool all clinical revenues at the system level (which allows for joint contracting with health plans) and, in return, to distribute funding to hospitals and faculty/physician organizations or departments through a performance-based methodology that rewards productivity, access, quality and safety, and economic efficiency.