by Edward L. Wristen
For more than a decade, health maintenance organizations (HMOs) seemed to be the managed care solution for employers concerned about the rising costs of premiums. HMOs were designed to save money by offering a controlled selection of covered services provided by network physicians. Over time, however, employee dissatisfaction and lower-than-expected cost savings sparked a shift in the healthcare environment, one in which employers and members alike were increasingly demanding more from their health plans.