Building a sustainable, risk-bearing IPA.

HMOs are increasingly relying on risk-bearing IPAs to expand their networks. Physicians see IPAs as a way to access HMO patients without relinquishing their autonomy. To build a sustainable IPA to bear global risk for HMO enrollees, the IPA's organizers should select a provider panel that is committed to centralized medical management and dominated by primary care physicians, invest in talented managers, empower a strong governing board, and access a management information system that can perform the functions necessary to manage care. Additionally, the interests of any potential outside capital sources should be weighed carefully, and the financial incentives of all of the IPA's providers aligned with the IPA's goal of providing appropriate, cost-effective care.