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Managed Care, Medicaid, and Public Health: Building Collaborations That Work
Roz D. Lasker, M.D., Director, Division of Public Health, New York Academy
of Medicine, New York, NY.
Collaboration allows people and organizations to achieve benefits that they could not
realize by themselves. It is the only way to achieve many health-related goals. It is a key survival strategy, not an extracurricular activity, because much of what health-related entities are expected to do is beyond their direct control. It is relevant to medical care and managed care, as well as to public health.
Collaborating is difficult to do effectively because of the fragmentation of the health system across sectors, players, services, and programs. However, collaboration can:
- Bring together sets of individual-level services (e.g., medical care, wraparound services, social services).
- Bring in more people than would otherwise be involved, particularly among target audiences.
- Bridge fragmentation between individual/clinical services and population-based health strategies, thus improving both.
Effective health-related collaborations are diverse, involving as equal partners people and organizations not traditionally associated with health (including businesses and
labor unions). Combining complementary perspectives, resources, and skills can generate tremendous power.
To create and sustain effective collaborations, all partners need to feel they benefit from participating. For example, Dr. Lasker noted that, to get physicians involved, those initiating a collaboration need to demonstrate how achieving the collaboration's goals would help the physicians' own practices. Also influencing the ability of diverse partners to work together are such factors as:
- Relationships between partners (e.g., trust that follow-through will occur, resources available to the person participating, and the benefit/drawback ratio will be positive).
- Collaboration as a whole (e.g., leadership, the governance/decisionmaking process, the collaboration's administration and management—which could be an independent entity—and ability to obtain resources).
- External environment (e.g., community history/trust, competition for resources/clients, and incentives/supports).
Structures are required to sustain good relationships and keep the people involved from burning out. Partners need to publicly receive credit for collaborations' successes. Dr. Lasker stressed that time is needed to develop relationships and a favorable climates for collaborations; once those relationships and climate have been developed, they can be used for multiple purposes.
Drawbacks of collaboration, which must be understood up front and minimized, include the facts that such collaboration:
- Takes time away from other activities.
- Takes away control of the issue.
- Can fail, resulting in the partners possibly being affected by the negative exposure.
- Can lead to frustration.
Halverson PK, Mays GP, Kaluzny AD, et al. Not-so-strange bedfellows: models of
interaction between managed care plans and public health agencies. Milbank Q 1997;75(1):113-38.
Lasker RD. Promoting collaborations that improve health. Fourth Annual Community-Campus Partnerships for Health Conference, 2000 Apr 29-May 2. New York (NY):
Center for the Advancement of Collaborative Strategies in Health, The Academy of
Lasker RD and the Committee on Medicine and Public Health. Medicine and public
health: the power of collaboration. Chicago: Health Administration Press. 1997.
Rawlings-Sekunda J. Trends in managed care. Portland (ME): The National Academy
for State Health Policy;2000 Feb.
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