Big new ideaBack in the early 1970’s, when I was a graduate student at the University of Kentucky with my wife and two small sons, we found ourselves without health insurance. Our previous experiences with health care were as children on our parents health insurance and the kindly services of the US Air Force. Uncle Sam paid for our two son’s births and early years.

One of our neighbors, as it turned out, was the first medical director of a new health maintenance organization. It was called the Hunter Foundation for Healthcare and was Kentucky’s first HMO.

They had rates based on ability-to-pay. With me as a graduate student on the GI Bill our ability to pay was extremely limited but again Uncle Sam was funding the HMO so he came to our aid again. This was a classic all-under-one-roof HMO that used a stage model for care. One’s first contact was by phone with triage by a nurse practitioner or physician assistant who decided who you would see. Then, when you came in you saw a nurse or PA, with a physician running in as needed and referrals to specialists or hospitalization. It was a good model. We enjoyed good care from them.

The Hunter Foundation HMO provided coordinated care across providers and reduced duplicative efforts. It was a model that deserved to succeed. It did not however draw enough paying clients to keep that model and thus has faded into history.

Good ideas always circle around and are rediscovered by the next generation as the “next great, new idea.” An article in the Austin American Statesman, describes a new plan by congress to create an new version of the HMO for Medicare recipients. It’s called the Better Care program and has the classic HMO structure of fixed monthly fees plus providers all-under-one-roof for better coordination across multiple chronic conditions and less duplication.

What’s your health care model and is it better?

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room:


  1. Alonzo-Zaldivar, R. Medicare proposal envisions flexible teams for chronic care. Austin American Statesman, January 16, 2014, A5.
  2. Health Maintenance Organization. Wikipedia, the free encyclopedia.
  3. Bentley-Smith, A. HMO-Founder Calls System a Failure, Calls for Medicare for All.
  4. Thomas, D. The Rise of HMOs. RAND Corporation, 2003.