Creating an integrated health care system as a basis for managed care excellence: a health plan's perspective.

Environmental factors and sentiments of leaders within health care organizations are stimulating the rapid evolution toward integrated health care systems. This article outlines the strategic considerations that led to the development of an organization spanning health care delivery, financing, and administration. The perspective is that of Medica, a successful health maintenance organization (HMO) operating in the mature and very competitive Minneapolis/St. Paul marketplace. Traditional approaches to managing care as a third-party intermediary were deemed unlikely to support future success and the next level of performance in meeting community needs. Key considerations, critical success factors, and a variety of unanswered questions are discussed.