Professional nursing practice in an HMO: the future is now

Managed care forms of service delivery now dominate the nursing practice environment. Nursing is potentially a key resource for helping the system to meet the increased and evolving demands, maintaining quality while decreasing costs. However, nurses need additional competencies to function effectively in this environment. Nurse educators need to prepare nurses for these new roles. This paper describes trends influencing nursing roles and identifies the nine categories of competencies needed by professional nurses practicing in HMO settings. Cost-reduction pressures have driven profound changes in the health care system in recent years. Countering these demands for cost-reduction are increases in costs driven by new, more expensive treatments and higher patient expectations. While the future of health care is anything but clear, certain features of the health care system seem relatively certain: major changes will continue to be cost-driven; more hospitals will close, or consolidate or collaborate to compete; and inpatient acuity will continue to increase. In addition, corporate America will increasingly influence how care is delivered and demands for information on health plan performance, such as the Health Employers Data Information System (HEDIS) (National Committee for Quality Assurance, 1997) will increase. These forces will inevitably redirect use of resources within health care organizations. Other external forces that will continue to influence how care is delivered are discussed below.