COMPETING HMOS COLLABORATE TO IMPROVE PREVENTIVE SERVICES

Background: In July 1993, an unusual collaboration developed between c ompeting managed care plans and with competing primary care clinics as part of a federally funded research grant (IMPROVE from the Agency fo r Health Care Policy and Research). The goal of this collaboration is to scientifically test the ability of an health maintenance organizati on (HMO) to improve the delivery of eight adult preventive services by training and facilitating the use of continuous quality improvement a nd prevention systems by contracted private primary clinics. Methodolo gy: In order to conduct this effectiveness study, it was necessary two HMOs to come to a structural and functional understanding of how to o perate jointly. Investigators recruited 44 private clinics for a rando mized controlled trial in which 22 are being assisted in improving the process used to deliver these preventive services and 22 are being le ft alone as comparison clinics. The intervention is a train-the-traine r and consultation approach focused on clinics as collaborating custom ers. The comparison will be based on repeated surveys of patients and clinic personnel as well as chart audits to measure changes in systems and prevention rates. Summary: Although this project was made possibl e by a number of unusual favorable factors, it can serve as a model fo r support of the clinician leadership that is essential to true health care delivery reform.