Managed care presents its own unique issues in credentialing, privileging peer review and hearings, not the least because of evolving economic models. Still, many of the same principals apply, As a result, they follow many of the same core ideas:


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• Now as much as ever, thorough HMO peer review is essential. The public, courts and legislatures are demanding reasoned decisions, not just “without cause” cuts.

• HMO provider certification is broader, more challenging and riskier than hospital credentialing. Certification standards and procedures must be up to the challenge.

• As managed care products evolve, HMOs must continually educate and update physician leaders on their unique roles in the plan.

• The competitive HMO environment demands simplicity. Certification and peer review processes are no exception.


To see how general principals carry over into managed care, click here.