HMO physician attitudes toward drug cost containment strategies.

OBJECTIVE: To compare network and group model physician attitudes toward prescription drug cost containment strategies. DESIGN: Mailed survey with two reminders for non-respondents. SETTING: Mixed model (network and group) HMO in metropolitan Washington, DC. MAIN OUTCOME MEASURE: Response on agreement scale to questions regarding receptivity to drug cost containment strategies. PARTICIPANTS: All primary care providers (N = 311) affiliated with the George Washington University Health Plan. The response rate was 78% (N = 243). RESULTS: Almost all clinicians believed that education and feedback were appropriate methods to control costs in an HMO. Network physicians were significantly less likely to agree with more intrusive administrative interventions. Both groups generally believed that patient expectations often dictate more costly prescribing than is necessary. CONCLUSIONS: Managed care physicians were generally amenable to cooperative behavior change strategies (i.e., education and feedback) and often opposed to mandated administrative or incentive approaches, especially physicians from the network setting. It remains to be seen whether use of cooperative methods to promote cost-conscious physician behavior can result in substantial savings.

The effect of an education and feedback intervention on group-model and network-model health maintenance organization physician prescribing behavior.

The authors evaluated the effect of an educational and feedback intervention on H2-blocker prescribing patterns and determined, if such effects differed for network- versus group-model health maintenance organization (HMO) physicians and in academic versus nonacademic settings. Physicians were randomized to receive an educational memorandum alone or combined with feedback regarding their individual prescribing behavior. The memo suggested preferred use of an H2-blocker (cimetidine) that would be less expensive to the HMO. Prescribing was monitored during the 6 months before and after the intervention. The study was undertaken at the primary care practices of a mixed group- and network-model university-affiliated HMO. Thirty group-model (at two academic and four nonacademic sites) and 33 network-model (all in full-time private practice) primary care physicians participated in the study. The analysis utilized weighted and unweighted analysis of covariance of the change in physicians' cimetidine-prescribing rates between the baseline and study periods. A significant response to the intervention was noted among academic and nonacademic group-model HMO physicians, but not among network physicians (adjusted mean absolute prescribing changes of +9.9% and +8.9% versus -2.8%, P = .02). There was no difference in prescribing change based on type of intervention (education versus feedback). The authors conclude that a simple passive educational intervention can be effective at changing group-model HMO physician behavior.