Impact of an HMO on a university-based family practice program

The impact over a 12-month period of a major increase in enrollment of prepaid insurance patients on the clinical, administrative, and educational activities of a university-based family practice residency program is described. Patient services increased by 40 percent, placing a heavy clinical load on faculty and third-year residents. There were significant increases in referral to psychology, psychotherapy, ophthalmology, and otolaryngology specialists. The high demand for services caused logistical difficulties for office and nursing staff. Adaptation to these changes and cost-containment efforts were hampered by institutional relationships. Strategies to manage the impact included hiring additional staff and part-time clinicians, introducing quality assurance and internal control procedures, and repeated orientation to the prepaid plan. Overall, the impact of the plan was of educational value to both residents and faculty.