Collaboration Among Competing Managed Care Organizations for Quality Improvement (1999) / Chapter Skim
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Session 3: Examples of Collaboration
Session 3: Examples of Collaboration
Pages 38-46
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From page 38... ...
The organization becomes involved when members of the Minnesota health care community agree that they have a common problem and would like to modify clinical practice or when the community would like comparative information to evaluate and compare the care provided by medical sites. Using practice guidelines as a blueprint for measurement and collaboration, HERF gathers data from sites using standardized data collection methods and makes the information widely available.
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From page 39... ...
However, HERF found that health care organizations and health plans had a great deal of trouble with the implementation of change across systems. For example, there is considerable acceptance of guidelines for the treatment of acute myocardial infarction by cardiologists, but there are many problems with fully integrating these guidelines into practice.
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From page 40... ...
The initial feasibility test included coronary angiography and adult asthma and sought ways to capture changes in functional status from a baseline and follow-up assessment. This partnership existed only because the employers brought the managed care organizations to the table and the plans participated to satisfy them.
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From page 41... ...
the perceived value of the product to the HMOs and physicians; (2) the economies and efficiencies derived from the collaborative effort, such as a single independent party doing the chart reviews; (3)
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From page 42... ...
None of these health plans owns hospitals. The New Hampshire legislature recently outlawed exclusive contracts, so provider networks are established primarily on a contractual basis, and the networks overlap.
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From page 43... ...
THE NATIONAL RURAL HEALTH ASSOCIATION Tim Size, M.B.A. The Wisconsin Rural Zones of Collaboration Initiative grew out of a series of open-ended discussions among HMOs and rural providers in the central and southern parts of the state initiated by the Rural Wisconsin Health Cooperative (RWHC)
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From page 44... ...
5. Identify and implement clinical quality management projects in which multiple practitioners, hospitals, health plans, and direct purchasers share a common interest at the local level and develop uniform performance objectives and outcomes measures to improve the health status of the populations served by multiple health plans.
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From page 45... ...
Develop a relationship based primarily on mutual trust so that the collaborative effort is not limited to the minimum performance inherent in written agreements. A number of factors are expected to be helpful: Perceived win/win/win for insurers/providers/public regarding the: demonstration of quality possible in rural areas; increased efficiency in the flow and use of data; and reduction of provider and plan "hassles." · Cooperation is not new in Wisconsin.
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From page 46... ...
Middle managers are reluctant to give firm responses, and frontline staff do not receive the history or the actual documents related to a project. Strategy: Use detailed agendas and meeting minutes, and disperse them widely; include staff members from multiple levels within the organization whenever possible; publicize significant accomplishments.
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