For years, COPC has been advocated as an effective approach for providing care to vulnerable communities. The Indian Health Service, for example, has practiced COPC in many of the communities it serves, as have a number of federally qualified community health centers (CHCs). Although private practitioners have been reluctant to practice community-oriented medicine, the incentives for them to do so are increasing. The pressure that managed care companies will place on physicians to adopt a community focus should not be underestimated. Increasingly, primary care physicians’ compensation will be tied to the health of their patients, their "community."

Population-based medical practice, as exemplified by managed care systems, is growing. Nationally, an estimated 75% of the privately insured population participates in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). A recent survey for Medical Economics found that 75% of all office-based physicians derive at least part of their income from HMOs or PPOs (Murray, 1994). The typical community-based physician participates in 2 or 3 HMOs and 2 or 3 PPOs, deriving 20% of his or her gross income from these sources in 1994. In addition, the federal and some state governments are implementing managed care systems as a way of controlling the costs of providing health services to the poor and the elderly. At present, seven states have received waivers to place their Medicaid population in managed care systems, while 23 additional applications are pending (Satcher, 1995). South Carolina will implement capitation for parts of its Medicaid population in January 1997.