We all know health maintenance organizations and their customers experience plenty of conflict. But ask where the center of the problems might lie, or even what these conflicts cost, you’re going to get heated, poorly documented, and hopelessly contradictory answers.

The most knowledgeable observers on all sides will admit that the scale of these organizations, the variety of issues that cause conflict, and the variety of ways they are addressed – or not addressed – make any current estimates essentially guesswork.

Designing means of identifying the major locations, sources, issues, and players in conflict in managed health care is the key to parties’ recognition of the problem’s true scale, pervasiveness and costs. That recognition, in turn, is the essential prologue to the major effort at systematic dispute prevention and resolution which, up to now, has been elusive.

As an early and deceptively simple part of an effort to build sophisticated tools for analyzing managed health care “dispute streams,” the authors of this article organized an unusual initial discussion for a selected cross-section of health care professionals, scholars and dispute resolution practitioners. This article will briefly describe the process used and some of the things the authors and the participants learned.