HMO productivity: back to basics

Significant reductions in health expenditures can best be achieved by a few inexpensive systemic changes in utilization of physicians rather than by multiple small savings from individual guidelines, pathways, etc. Capitation was a systemic change that removed the fee-for-service incentive to increase income by increasing visits. What is needed now is to change the scheduling patterns and demand needs of the population adopted under fee for service. By designing schedules to reduce no-shows, facilitating a reduction in the number of visits per patient per year, and preferentially accommodating acute primary care visits and consultations, HMOs can rapidly reduce demand and achieve substantial savings.