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Integrated Delivery Systems In Managed Care

Challenges to Public Purchasers

Contracting With Integrated Delivery Systems


James A. Chase, Director of Purchasing and Service Delivery, Minnesota Department of Human Services, St. Paul, MN.

This session focused on the purchase of services from integrated delivery systems (IDSs) by public purchasers, especially Medicaid, highlighting who to contract with and what to contract for.

Mr. Chase explained that the challenges are greater in long-term care and disability programs rather than in acute care. He said that in Minnesota, establishing an adequate primary care network is going well but that ancillary care (e.g., home health) is more of a challenge.

Other challenges facing public purchasers include:

  • Determining appropriate provider payments and risk adjustment.
  • Educating recipients.
  • Plan features.
  • Portability.
  • Lack of competition in rural areas.
  • Capacity of the IDS to manage and monitor all care provided.

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