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Local Health Departments in a Managed Care Environment

The Changing Environment

A Discussion of Challenges, Opportunities, & Policy Issues


Lawrence Bartlett, Ph.D.

This session established a context for the overall workshop by having participants identify the key issues that they and their local health department (LHD) colleagues must now address as many of the populations they have traditionally served are enrolled in managed care arrangements.

The general consensus was that the changes taking place in the health care marketplace require LHDs to reassess their current activities and that many LHDs will have to change what it is they do. The changes most often discussed included eliminating LHD involvement in the direct delivery of personal health care services and increasing LHD involvement in the monitoring and oversight of managed care activities.

While a number of participants felt forced into making these changes as a result of a loss of Medicaid revenues, many observed that a compelling reason for change was the opportunity for them to redirect resources toward core public health activities that could have a significant positive impact on community health status.

However, among the key challenges identified by participants in making the necessary changes were the following:

  • How to identify which existing activities/services to maintain and which new ones to add? A set of key questions to ask about a LHD's current activities included in the Agency for Health Care Policy and Research's (AHCPR) Assessing Roles, Responsibilities, and Activities in a Managed Care Environment: A Workbook for Local Health Officials (AHCPR Pub. No. 96-0057), was referenced as a useful guide for making these decisions.
  • If LHDs move away from direct service delivery, how will the needs of the uninsured be met?
  • How can LHDs develop the necessary staff expertise and systems resources to play an effective role in today's health care environment?


Showstack J, Lurie N, Leathermah S, et al. Health of the Public: The Private-Sector Challenge. JAMA 276(13):1071-4.

Baker E, Melton R, Stange P, et al. Health Reform and the Health of the Public: Forging Community Health Partnerships. JAMA 272(16):1276-82.

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