What have HMOs learned about clinical prevention services? An examination of the experience at Group Health Cooperative of Puget Sound.

Over the last 20 years, HMOs have begun to develop population- and evidence-based systems for their clinical prevention services. Because of their integrated information systems and staff communications, HMOs are uniquely positioned to help physicians to identify systematically the primary risk factors or secondary prevention needs of individuals and to provide specific referral or screening services and off-site telephone counseling services to effect seamless, organized intervention. A review of the relevant published literature was combined with the empirical experience of the Group Health Cooperative of Puget Sound in Seattle to illustrate the approach of one large staff-model HMO. Challenges for the future include creating clinical information systems, establishing adequate funding, instituting practitioner incentives, training practitioners for behavioral change, and developing and integrating patient self-care.