In an effort to reclaim the local delivery systems from national insurers and to regain continuity in the physician/patient relationship, physicians are forming their own Health Maintenance Organizations in both rural markets and areas saturated with commercial HMOs.

We present original research in this monograph gathered by contacting over 90 health plans that were categorized in AAHP's database as "provider-owned" health plans. The initial contacts were made to the offices of medical directors of the plans to determine what sort of provider- hospital, physicians, health system, medical center- owned the plan. Once the form of ownership of each plan was determined and clearly distinguished as physician-driven or owned, we profiled the physician-driven plans. Of the 15 physician-owned, designed HMOs that we profile in this study, there is no one established path that each took to achieve success in their market today. There are certain market conditions that provided an impetus for the physicians to begin the discussion of HMO formation, and there are logical steps that the physicians took once they had a clear vision of the formation of an HMO.

This monograph highlights ten characteristics of the formation of a physician-owned health plan determined from the histories of the plans that we profiled. In addition, we present four in-depth case studies of physician-driven health plans.