Collaboration Among Competing Managed Care Organizations for Quality Improvement (1999) / Chapter Skim
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Competition has existed at the provider level in the pre-managed care era and continues among physicians, physician groups and hospitals today. What is new is the extent of competition at the managed care organization level in individual regional markets.
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Potential areas for collaboration include: · the identification of substandard practitioners, in part through carrying out the objectives of the Health Care Quality Improvement Act of 1986; · joint practitioner educational efforts; · joint public education efforts; and · joint development of guidelines for the use of effective therapies. ANTITRUST ISSUES Although one can make a plausible case for collaboration, there are barriers.
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It would be unwise for competitors designing collective action to rely on being able to defend anticompetitive actions by pointing to good intentions, some alleged market failure, or arguable improvements in the quality of health care. Even if a given market were seriously imperfect, antitrust law provides no clear and reliable reason for competitor groups to substitute their own judgments for those of the market.
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For example, an agreement to use only a designated provider could be characterized as a boycott of other providers. A collaborative strategy of promoting quality by encouraging local providers to become "centers of excellence" would avoid antitrust problems only if the collaborators confined their effort to collecting information on comparative performance.
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Although antitrust law has often been invoked by competitors injured by the circulation of information, modern courts are increasingly inclined to recognize that the Sherman Act was intended by Congress to protect "competition, not competitors." A number of imperfections in the health care market could be addressed by collaborative action. Cooperation makes sense in several areas: when the science is compelling; when plans are common customers of a supplier as well as being competitors; and when adverse outcomes occur rarely, and competitors want to use scientific methods to help guide improvement.
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