A public-sector HMO in a competitive market: ensuring equity for the poor.

While managed care is still a new concept in much of the country, it has been a reality in the Minneapolis-St. Paul area for more than three decades. Metropolitan Health Plan (MHP), a public-sector, county-owned health maintenance organization (HMO), was developed 10 years ago as a mechanism to ensure retention of the county hospital's historical patient base if the state of Minnesota were to mandate managed care for public-assistance patients (which occurred in 1985). Because MHP's chief provider organization was Hennepin County Medical Center, which has a long history of serving the poor, it had an advantage over its more established competitors. MHP's greater knowledge of the population and sensitivity to ethnic and cultural diversity has enabled it to develop programs and systems to streamline access to services, many of which are unique to MHP.

Lessons from a teaching hospital's HMO.

In 1983, a Minneapolis teaching hospital and its county government came up with a non-traditional approach to bolstering the hospital's bottom line and addressing the county's indigent care problem--a health maintenance organization to serve the county's large Medicaid population. Five years later, all involved agree that the solution was a sound one.

Clinic expands adolescents' access to care: Health promotion.

A Minneapolis health center opened a mini-clinic in a local high school to provide adolescents with better access to care, appropriate referrals, and health education.