THE IMAGE a group of small, independent home medical equipment providers envisioned five years ago of their industry's future was frightening. They foresaw a competitive managed care market that favored the big guys. It was time for bold brush strokes.

The Home Care Alliance of Virginia is their response to that vision. The alliance is an ever-evolving network of 25 companies-at last count-that have come together to provide coverage blanketing Virginia and West Virginia and stretching into seven other states and Washington.

The alliance was formed in 1995 with two founding companies and three goals:

* To obtain managed care contracts. Because many companies in rural Virginia are small, they couldn't get contracts without muscling up the ability to provide broader service, says Wayne Stanfield, executive director of the alliance in Halifax, Va.

* To support alliance members. This is accomplished through collective training, such as offering classes to prepare for Joint Commission accreditation, or programs that help them measure outcomes against each other and national data.

* To reduce the cost of operations by using the network to develop a small but powerful buying group.

"It's helping member companies become better providers," Stanfield says. "We've been able to reduce costs on the one hand, and gain contracts and referrals on the other."

"I think the alliance has [increased efficiency] as well because of topics such as performance improvement," confirms Sam Clay, president of Petersburg, Va.-based Clay Home Medical. "We've been able to gather data within the alliance to compare with national data to judge our own performance and also within the alliance to have a uniform level of quality that we can present to managed care organizations."

More important, the alliance has helped members secure contracts and referrals from managed care organizations that look for much broader regional coverage from service providers.

"By presenting the alliance as a group, we're able to make referrals easy for managed care entities because they can make one call and take care of patients anywhere in the state of Virginia," Clay says. "It's a convenience that makes us attractive, so we're able to get contracts. Without being in the alliance, I wouldn't have access to several of the HMOs involved because some have closed provider networks.

"The alliance in general has been a successful venture-and it's been very successful for my company. It has helped each of its members to prosper, and as managed care becomes more prominent in health care, it's going to be the vehicle which we use to become even more of a market player."