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Integrated Delivery Systems In Managed Care

State Interagency Collaboration

Presenter:

Jane Horvath, National Academy for State Health Policy.


Ms. Horvath reviewed several factors that might promote interagency collaboration in managed care oversight. Among them are:

  • Growth of managed care in the commercial sector.
  • 41 percent of all workers were in health maintenance organization (HMO)/point-of-service (POS) arrangements in 1995 compared with 25 percent in 1992.
  • Increasing political pressure for more and better oversight.
  • Growth of managed care in the Medicaid program.
  • 8.2 million risk enrollees in 1995 compared with 5.4 million in 1994.
  • Limited beneficiary choice.
  • Multiple State agencies are often involved in overseeing managed care entities leading to unnecessary duplication.

She offered that there is often potential for greater collaboration regarding standards and monitoring of finances, quality assurance, grievance procedures, and licensing.

Ms. Horvath also advised that agencies build collaborative models incrementally and that agencies start with areas where change is readily achievable.

Reference

Horvath J, Snow KI. Emerging Challenges in State Regulation of Managed Care: A Report on a Survey of Agency Regulation of Prepaid Managed Care Entities. National Academy for State Health Policy, August 1996.


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