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Integrated Delivery Systems In Managed Care
The Evolving Managed Care Marketplace
Can the Empire Strike Back?
Robert E. Hurley, Ph.D., Associate Professor, Department of Health Administration, Medical College of
Virginia, Richmond, VA.
Dr. Hurley likened recent trends in the managed care marketplace to living through a "revolution" where employers and
purchasers are in a position of ascendancy, and consumers are more empowered, engaged in the process and exerting
pressure on providers to negotiate and deliver better value for the health care dollar.
Various managed care models are
emerging in response to these forces, with integrated delivery
systems (IDSs) either complementing health maintenance organizations (HMOs) (e.g., by contracting to
serve as the delivery network), or competing with them by offering their own health plan. This raises questions for the
- Quality assurance oversight.
- Public purchasing issues.
The challenge is to formulate
good public policy before fully understanding the consequences of the managed care revolution.
Brown M. Mergers, Networking, and Vertical Integration: Managed Care and Investor-Owned
Hospitals. Health Care Management Review Winter 1996:29-37.
Conrad DA, and Shortell SM. Integrated Health Systems: Promise and Performance. Frontiers of Health
Services Management 13(1):3-40.
Gold MR, Hurley R, et al. National Survey of the Arrangements Managed-Care Plans Make
With Physicians. New England Journal of Medicine 1995;333:1678-83.
Goldsmith JC. The Illusive Logic of Integration. HealthCare Forum Journal September/October 1994:26-31.
Morrisey MA, Alexander J, Burns LR, and Johnson V. Managed Care and Physician/Hospital
Integration. Health Affairs Winter 1996:62-73.
National Health Policy Forum. Trends in Health Network Development: Community and Provider Initiatives in a Managed Care Environment. Issue Brief 1996, No. 690.
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