The promise of HMOs: primary care, prevention, research and education.

The contributions of HMOs to research and education are important in the generation of knowledge for policy development and for training physicians to meet the needs of populations. While prepaid group practices that were the prototypical HMOs added important new information about the organization and delivery of health services, the new generation of managed care organizations has not been involved in either research or teaching. Issues that are particularly amenable to research in HMOs include the appropriate balance between primary care providers and specialists, criteria for referral from primary care to specialty services, the contributions of preventive care to health, and the testing of alternative strategies to achieve the four important characteristics of primary care practice. HMOs could also make important contributions to medical education by exposing students and residents to quality of care assessments and to practice-based research, as well as to the special challenges and rewards of population-based medical care.