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For care delivered in HMO settings to be effective, patients with chronic diseases as well as healthy individuals should receive appropriate care from the appropriate providers at the appropriate times. In a study by researchers at the University of California, San Francisco (UCSF)1, patients with systemic lupus erythematosus (SLE) enrolled in HMOs had lower use of outpatient physician visits and less use of diagnostic testing, along with fewer outpatient surgeries and hospital admissions, than those enrolled in FFS health plans. Although providing the proper primary and preventive care often results in lower healthcare utilization and cost, the relationship between utilization and outcomes in complex SLE patients is more tenuous.