FIGURE 1.1 Number of HMO enrollees, 1976–1995. SOURCE: HIAA (1996a).

sion of managed care into the public sector, consultants are now providing technical assistance to state agencies that want to make informed purchases and hold managed care organizations accountable for the public dollars spent.

Key stakeholders in the industry also include the private national organizations that accredit both provider agencies and managed care entities. Technically, accreditation is voluntary, but many public and private payers encourage or require that their practitioners maintain accreditation. These accreditation entities address organizational capacity, internal management and quality improvement processes, and related issues. In general, accreditation standards are evolving, and the standards for individual practitioners are better developed than the relatively new standards for managed care plans. Chapter 6 of this report discusses five of the organizations involved in accreditation for managed behavioral health care: the Rehabilitation Accreditation Commission (CARF), the Council on Accreditation of Services for Families and Children (COA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), NCQA, and the Utilization Review Accreditation Commission (URAC).

Managed care entities also carry out significant quality functions within their contracts and care networks. Examples of these functions include credentialing and recredentialing clinicians; practice guidelines; and profiles of practice patterns, outcomes, and consumer satisfaction for individual practitioners. These functions are sometimes labeled as the “black box” of managed care, because al-