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When the Massachusetts General Hospital and the Brigham and Women's Hospital announced their plans to merge in 1994, the idea of two prestigious academic centers joining together was novel. Now, almost three years later the merged entity, Partners Health Care System, Inc., has become a model for many academic health centers seeking strength in a time of fiscal uncertainty. Richard Nesson, MD, began his relationship with Harvard in 1954 as an undergraduate and now as president of Partners he has the task of directing Harvard's two largest hospitals. Through solid strategic planning and financial management, Nesson has been able to effectively position Partners to respond to increasing managed care pressures. Interviewed at Partners' headquarters in the Prudential Building in downtown Boston, Nesson discussed the growing penetration of managed care in New England and the challenges of maintaining the multiple missions of academic medical centers in an increasingly financially-oriented market.