Improving Performance in a Contracted Physician Network. (Positively Influencing Physicians)‪.‬

MANAGED CARE organizations (MCOs) are faced with the challenge of influencing physician behavior to achieve business, clinical, and service performance. This task is especially difficult for non-staff and group model MCOs that contract with networks of independent physician practices. We have learned some Important lessons about the kind of collaboration that is necessary to improve performance at Tufts Health Plan (THP) in Waltham, Massachusetts. After initiating a Medicare HMO in the 1980s that failed, THP decided to develop another program in the 1990s with the help of PacifiCare Health Systems, whose Secure Horizons (SH) product was the nation's largest Medicare HMO. They assigned significant financial risk to the medical groups, while structuring the contracts so that they could thrive financially with appropriate utilization and quality controls. THP contracted in a similar fashion with 20 independent medical groups in Massachusetts and launched its program in 1994.