In order to examine a more typical arrangement, The Lewin Group decided to focus on integrated health maintenance organizations (HMOs) for this study. Consequently, The Lewin Group identified participants based on the following criteria:
- Receive favorable NCQA ratings;
- Offer nationally-recognized behavioral health programs;
- Cover over 500,000 lives;
- Operate under at least one of the following models: group, staff, network, PPO; and
- Operate in geographically diverse regions.
Additionally, the pool of HMOs interviewed were required to represent a variety of financing mechanisms and risk-sharing arrangements (i.e., fee-for-service, capitation) as well as pharmacy management models (i.e., in-house, carve-out). The final HMOs selected included: FirstOption, Harvard Pilgrim, HealthPartners, Group Health, and Kaiser Permanente.
|HMO||Reason For Inclusion|
|First Option (New Jersey) (250,000, consolidated w/Physicians Health Services as of 1/2000)||
|Harvard Pilgrim (1.6 million)||
|HealthPartners (Minnesota) (800,000)||
|Group Health Cooperative of Puget Sound (Washington) (600,000)||
|Kaiser Permanente Mid-Atlantic (540,000)||