By the mid-1980s, it was clear that not all transplant centers in the growing organ transplantation market were able to achieve and sustain the same levels of quality and high rates of transplant procedure success. Similarly, significant variation had emerged in the cost of these complex and expensive procedures. Within this dynamic environment, United Resource Networks (URN) was founded in 1989. The express purpose of this new organization was to manage variation in the transplantation process to enable the delivery of higher quality, lower cost, more predictable results to patients, employers, and health insurers. The company would accomplish this by establishing a virtual network of transplant centers that were made available to its customers through preferred contracting arrangements. By 2004, URN had built the largest transplantation network in the United States, growing at an average annual rate of 40 percent over the last ten years. With 4,000 customers and 44,000,000 covered lives, the network managed approximately 10 percent of the nation's organ transplants each year. This paper explores the URN business model as an example of the innovative strategies being used by health plans to carefully manage complex medical conditions and control the risks associated with expensive procedures, such as organ transplants.
