With help from The Tompkins Group, the Hartford (Connecticut) Physician Hospital Organization (HPHO) organized its physicians into risk sharing "pods" to manage two global capitation contracts covering 60,000 lives. Recognizing that its success with these contracts depended on effective medical care cost and quality control, HPHO engaged The Tompkins Group, assisted by The Pace Group, to develop a comprehensive Medical Management (MM) Program.

Seeking to eliminate duplication of effort and resources among the risk sharing parties (payers, hospital, and physicians), HPHO’s MM Program was designed collaboratively with the HMOs’ utilization management nurses, hospital discharge planners and HPHO physicians. The core was a "case management" program that integrated inpatient, outpatient, and physician services – an approach that was new to Hartford. Case managers centralized at HPHO coordinate health care services before, during and after hospitalization and act as the focal point of contact for patients and providers. The program has succeeded in both controlling healthcare costs and reducing confusion.

Based on an analysis of health plan membership and the number of participating providers, recommendations for appropriate case manager staffing levels were developed and a data analyst was hired to examine high-cost, high-risk events and associated patterns of practice. Included in the MM Program development was in-depth training of case managers, the development of policies and procedures, and assistance in recruiting a new Medical Director and Director of Medical Management (RN, MBA) to execute the program.