Assessing Roles, Responsibilities, and Activities in a Managed Care Environment

A Workbook for Local Health Officials

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The Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) User Liaison Program (ULP) translates, synthesizes, and disseminates health services research findings, in easily understandable and usable formats, to State, local, and Federal policymakers through interactive workshops.

Assessing Roles, Responsibilities, and Activities in a Managed Care Environment: A Workbook for Local Health Officials, is the result of a collaborative effort between ULP and a public health work group comprised of representatives from the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the Association of Maternal and Child Health Programs (AMCHP).

The workbook is a 275-page, spiral-bound, 11 1/2" by 8" document with laminated covers. A free copy can be obtained from the Agency Clearinghouse by calling toll-free 800-358-9295 and requesting AHCPR Pub. No. 96-0057.

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Overview

The monumental changes occurring within the health care marketplace are having a dramatic impact on all health care providers, payers, and policymakers, including local health officials. Determining the proper direction for a local health department (LHD) in the midst of such changes can certainly be a daunting task. The workbook seeks to assist local officials in examining the changing marketplace, and in charting a logical and appropriate future course for their individual LHDs.

The workbook's purpose is not to prescribe what individual LHDs should do or what their roles should be in the future, but rather to highlight the issues and questions that can help local officials assess and implement alternative roles, responsibilities, and activities for their LHDs in a managed care environment.

In particular, the workbook attempts to help LHD officials identify appropriate ways to carry out their core responsibilities in this new environment by identifying key policy initiatives or design features that may be important to consider in LHD's policy development efforts as well as important questions, factors, and the different roles for LHDs raised by the increased prevalence of managed care arrangements.

Chapter Summaries

Each chapter identifies a series of important questions that local health officials should seek to answer in the process of developing a strategic plan for their LHDs. Most conclude with a broader set of questions/issues that should help LHD officials synthesize the information they collect and identify key action steps to be taken or decisions to be made.

After the introduction (Chapter 1), the individual chapters of the document are structured to help LHDs:

• Catalog an individual LHD's current mission statement, activities, and capabilities (Chapter 2).
• Examine the changes taking place at the State and Federal level, including overall market trends and State managed care initiatives, particularly those affecting low-income persons traditionally served by many LHDs (Chapter 3).
• Assess managed-care related changes taking place at the community level (Chapter 4).
• Identify new approaches and opportunities for carrying out core public health functions in a managed care environment (Chapter 5).
• Analyze utilization and cost information on health care services the LHD provides (Chapter 6).
• Explore and assess alternative roles that individual LHDs could play in the direct delivery of personal health care services to the community, including but not necessarily limited to the community's vulnerable populations, within a managed care environment (Chapters 7 and 8).
• Think about the next steps to take in the process of deciding about managed care-related roles and responsibilities for LHD's, including examining ways in which state public health agencies can assist and support LHDs in defining their future roles (Chapter 9).

Tools and Resources

The workbook includes several assessment tools that LHD's can use, including:

• Inventory of personal health care and enabling services your LHD currently provides.
• Your community profile.
• Self-assessment of how well your LHD carries out core public health functions and activities.
• Revenue analysis of LHD services for selected third-party payers.
• Factors influencing the LHD's decision to provide services in a managed care environment.

In addition to a list of references, resource appendices are provided:

• Glossary of common managed care terms.
• Phone numbers and addresses for designated State/local health liaisons within State Health Departments.
• State Insurance Commissioner's offices.
• State Medicaid offices.
• National Association of County Health Officials 1992 National Profile of Local Health Departments.
• State 1115 and 1915(b) Waiver Program updates (of May 17 and March 30, 1996, respectively) prepared by the Health Care Financing Administration.

Current as of January 1997