This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Strengthening the Rural Health Infrastructure
Managed Care & Network Development
Todd Sorensen, M.D., Medical Director, Regional Care, Inc., Scottsbluff, NE.
Benjamin H. Robbins, M.D., Medical Director, Health Alliance Medical Plans, Carle Clinic, Urbana, IL.
This session provided examples of provider network organizations and managed care plans operating in rural areas. Dr.
Sorensen suggested that the market in the Nebraska panhandle—where there are great distances, low population density
and local control issues—was ripe for "virtual integration" of multiple providers through contracts. He described the steps it
took to form the joint venture known as Western Health Partners which offers Preferred Provider Organizations (PPOs), point-of-service (POS), and health maintenance organization (HMO) products, and what
steps must yet be taken to assure future viability and success.
Among the lessons learned about forming networks that he
shared with the audience were:
- Physician leadership is crucial.
- A compelling reason to form a network is a requirement.
- It will take longer than you think it should.
- Members do have to cede some power to the network.
Dr. Sorensen felt that State Offices of Rural Health could be helpful to newly emerging networks by educating rural providers and
consumers on the concepts of managed care, with validating network leaders' efforts and with facilitating Medicaid
contracting. Dr. Sorensen also said that antitrust protections may be useful for some rural networks.
Dr. Robbins examined the contribution to rural health care made by an integrated delivery system (IDS). From his
experience at Carle Clinic and networking with other large HMOs, he suggested that an IDS can decrease health care
costs, increase standardization of care, increase access to primary care physicians and specialists, and keep local hospitals
alive. He feels that public health care policy has had its pluses and minuses. He considers the new formulas in the Balanced Budget Act
Other pluses are:
- The 1970 HMO laws, which allowed rural hospital growth.
- The establishment of rural health clinics.
- Incentive programs for getting new physicians to underserved areas.
Dr. Robbins considers antitrust laws, any willing
provider laws, variable reporting requirements, and slow bureaucracy as negatives. He feels there is an
opportunity now for public policy to support managed care and to increase support for rural hospital infrastructure. He
predicts that there will be 20-30 national health care corporations and population based health care in the future.
Previous Section Contents