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Managed Care

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Managed care research has come of age

Four years ago, the Agency for Health Care Policy and Research and the American Association of Health Plans sponsored a conference to promote collaboration between managed care organizations (MCOs) and the health services research community and to potentially provide answers to some critical questions related to quality, access, and costs of managed care. Over the years, conference goals have expanded, and the conference agenda has changed to reflect these goals.

"Building Bridges IV: Improving the Public's Health Through Research Partnerships" was held May 7-9, 1998. Based on presentations made during the conference, a special supplemental issue of Medical Care Research and Review (volume 56, supplement 2) was published in April 1999. Articles contained in the issue illustrate how the conference agenda has developed and demonstrate just how far managed care research has evolved. For example, the conference agenda and discussion show that the two worlds of managed care and research are no longer distinct and separate. Rigorous, objective, public domain research is occurring both within and outside of MCOs. Also, many MCOs have substantial research capacity within their own or affiliated organizations.

The 1998 conference focused not so much on partnerships as on the substance of managed care research and the challenges faced by researchers as they attempt to look inside the "black box." Indeed, the research community has shifted its focus away from questions about the overall impact of managed care to an examination of particular managed care arrangements, such as carve outs for mental health care and their impact on certain populations under certain circumstances. Of particular interest is the impact of certain managed care arrangements on vulnerable and chronically ill populations, including children.

Conference participants questioned established theories of how markets do and will work, with particular emphasis on the role of consumers and purchasers. In addition, MCOs were characterized as extremely powerful laboratories for learning how health care is delivered now and how it can be improved in the future. Conference participants called for building new bridges and partnerships—for instance, between academic health centers and MCOs—for this research to reach its potential. The following conference papers were published in the special supplement:

  • Baum, H.B., Logemann, J.A., and Stenzel, B.A., "Initiating a clinical trials cooperative group in an increasingly managed care environment: Successes and problems in establishing collaboration," pp. 139-152.
  • Fraser, I., Wong, H.S., Arent, J., and Bocchino, C. "Building bridges IV: Managed care research comes of age," pp. 5-12. Reprints (AHCPR Publication No. 99-R063) are available from the AHCPR Clearinghouse.
  • Grazier, K.L., and Eselius, L.L., "Mental health carve-outs: Effects and implications," pp. 37-59.
  • Parkerton, P.H., "Motives for health plan-academic health center relationships: Journal review of the first quarter century," pp. 111-138.
  • Scanlon, D.P., and Chernew, M., "HEDIS measures and managed care enrollment," pp. 60-84.
  • Simpson, L., and Fraser, I., "Children and managed care: What research can, can't, and should tell us about impact," pp. 13-36. Reprints (AHCPR Publication No. 99-R062) are available from the AHCPR Clearinghouse.
  • Wong, H.S., and Smithen, L., "A case study of point-of-service medical use in a managed care plan," pp. 85-110. Reprints (AHCPR Publication No. 99-R061) are available from the AHCPR Clearinghouse.

For more information, see "Building Bridges IV: Improving the Public's Health Through Research Partnerships," Special Supplement to Medical Care Research and Review 56 (Suppl. 2), 1999. Copies of the supplement (AHCPR Publication No. OM99-0007) are available from the AHCPR Clearinghouse.

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