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Rural communities motivated to develop managed care networks benefit most from technical assistance programs

More than one in four people (27 percent) in the United States is enrolled in a managed care program, but the growth of risk-based managed care has lagged in rural areas. In 1995, less than 10 percent of the rural population in eight States was enrolled in a commercial HMO compared with 26 percent of the urban population in the same States.

The rural communities most motivated to integrate into managed care systems are those who perceive the threat of managed care from outside their community. This may be due to increased market activity by regional or national managed care organizations (MCOs) or efforts by large regional hospitals in nearby urban areas to draw rural providers into their networks. Rural providers in these communities have strong incentives to band together, but to operate effectively, they need a great deal of resource-intensive technical assistance. In 1994, the Agency for Health Care Policy and Research funded five university-based technical assistance projects to help rural providers in six States—Arizona, Maine, Oklahoma, West Virginia, Nebraska, and Iowa—prepare to participate more effectively in managed care through the development of rural health networks.

The project offered technical assistance to help rural communities develop rural health networks to participate in managed care. Technical assistance efforts varied according to the extent of each site's network and managed care activity. Three projects (Maine, Nebraska and Iowa, and West Virginia) provided organizing support needed by fledgling provider networks to contract with MCOs. Other projects assisted in community development as a first step toward network development and managed care in Arizona, West Virginia, Nebraska, and Iowa. Finally, the project provided support for loose provider coalitions in Maine. A recent evaluation of the program (supported by AHCPR contract no. 290-93-0038) was conducted to assess its effects and provide guidance to other organizations considering similar technical assistance efforts.

Some sites made substantial progress toward system integration during the first 3 years of the program. Yet in other sites, provider groups were less cohesive and their goals less clear, and they were least prepared for managed care. They were arguably most in need of technical assistance, but because members were not strongly motivated to cooperate, the technical assistance had little immediate impact on the health care delivery system. Thomas C. Ricketts, Ph.D., of the University of North Carolina, and colleagues conclude that technical assistance projects are insufficient on their own to spur network development. Instead, real movement toward system integration usually requires pressure from larger forces external to the community.

For more details, see "Preparing rural communities for managed care: Lessons learned," by Nancy J. Fasciano, M.P.A., Suzanne Felt-Lisk, M.P.A., Dr. Ricketts, and Benjamin Popkin, J.D., M.P.H., in the Winter 1999 Journal of Rural Health 15(1), pp. 78-86.

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