The future may hold some predicaments for the medical profession, as wellness services, IPA's, and MCO's may become a more integral part of the health care horizon, but the relationship may not have to be a malevolent one, as relationships may be beneficial to health and medical specialists. This is discussed in the next section.

HMO's and the Push for Prevention
Leaf has suggested in his article in JAMA that the move to prevention may be a natural extension in medicine based on health care cost escalations. It is doubtful that most medical organizations will jump on the bandwagon soon (because physicians are still trained in treating the sick, not preventing disease). However, organizations such as the Association of Hospital Health and Fitness, Florida Hospital Association, National Wellness Institute, American Institute of Preventive Medicine, etc. have all developed instructional tracks to teach professionals about the basics of dealing in the managed care environment - from outcomes assessments to contracting for services. HMO's will contract with professionals from these organizations because of the profitability of doing so. In contracting for one sum of money per month (or year), the burden of maintaining profit margins now falls on the provider. Managed care benefits because their payments are constant. Providers who understand how to work in this business environment can increase revenues at a time when many in rehab are seeing revenues decline.

Therapy and Wellness
Working relationships with allied health professionals and wellness practitioners may soon expand because the push for prevention may see more of a "one stop shopping" mentality among payors. In other words, they would like to see many types of services under one roof. If traditional rehabilitation practitioners can incorporate wellness services into their practices, they may be more accessible to HMO contracts in the near future. As contracting becomes the norm in terms of reimbursement, the matching of the professions may be more than a good bargain, it may be a necessity.

In closing, perhaps the best reason for an alliance is the most important. Having many services under one roof means more help for patients. In the push for managed care, many health care professionals measure the changes in terms of dollars. Patients still measure changes in terms of the quality of their care. Many of these patients are upset at the system because of a lack of caring for their condition, more difficulty in seeing their own physicians, and trouble in reimbursement for miscellaneous services. A program that can help patients both in the acute phase and long term rehab needs will be in demand in future health care contracting, and will be in favor with patients who are seeking more from their health care system than just routine diagnostic tests and prescription drugs for most of their conditions. The next few years will see a system that incorporates both wellness and rehabilitation to treat patients, educate them, and control costs over the long haul.

References
1. Banja, J.D. Ethics, outcomes, & reimbursement. Rehab Management. 1994, Dec./Jan. pp. 61-65.

2. Bly, J.L, Jones, R.C., Richardson, J.E. Impact of worksite health promotion on health care costs and utilization. JAMA. 1986. 256:3235-40.

3. Borzo, G., McCormick, B., Somerville, J., Voelker, R. Pulling for a piece of the healthcare market. American Medical News. 1993. pp-3,9,47, April 19.