Collaboration among competing managed care organizations for quality improvement : summary of a conference, November 13, 1997 / The National Roundtable on Health Care Quality, Division of Health Care Services, Institute of Medicine ; Molla S. Donaldson, editor.

Format:

Book

Contributor:

Donaldson, Molla S.

National Roundtable on Health Care Quality.

Institute of Medicine (U.S.). Division of Health Care Services.

Language:

English

Subjects (All):

Managed care plans (Medical care)--United States--Congresses.

Managed care plans (Medical care).

Physical Description:

1 online resource (61 p.)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1999.

Language Note:

English

Summary:

In November, 1997, The Institute of Medicine convened a one-day conference to explore areas for potential collaboration to improve quality among competing health plans consistent with antitrust and other legal requirements. The conference was convened to clarify the limits of such potential activities and to explore ways to stimulate collaboration; in short, to explore permissible and promising areas for collaboration for competing health plans. Competition has existed at the provider level in the pre-managed care era and continues among physicians, physician groups and hospitals today. What is new is the extent of competition at the managed care organization level in individual regional markets. As large numbers of individuals are enrolled in health plans, the potential for new forms of cooperation for improving quality of care becomes possible. Along with these new possibilities, however, come questions about whether they bring the potential for antitrust violation.

Contents:

Collaboration Among Competing Managed Care Organizations for Quality Improvement

Copyright

PREFACE AND ACKNOWLEDGMENTS

Contents

SUMMARY

Why Do Organizations Collaborate?

Antitrust Issues

Standard Setting

Information Collection and Exchange

Selecting High-Quality Providers

Lobbying and Working with Government

Conclusion

SESSION 1: CONCEPTUAL ISSUES IN COLLABORATION

INTRODUCTION TO COLLABORATION

Potential Areas for Collaboration

Issues for the Conference

LEGAL ISSUES IN COLLABORATION

Some Rudiments of Antitrust Law

Specific Pitfalls to Be Avoided

Group Boycotts.

Other Naked Restraints.

COLLABORATION FOR QUALITY IMPROVEMENT AMONG MANAGED HEALTH CARE ORGANIZATIONS: WHAT CAN BE LEARNED F ...

Why Do Organizations Refuse to Collaborate?

How Are These Examples Relevant to Health Care?

SESSION 2: PANEL PRESENTATIONS

LESSONS FROM THE ELECTRONICS INDUSTRY

ANTITRUST REGULATION

THE LIMITS OF COMPETITION

THE MEDICAL DIRECTOR'S PERSPECTIVE

SESSION 3: EXAMPLES OF COLLABORATION

HEALTH CARE EDUCATION RESEARCH FOUNDATION

THE EMPLOYERS' MANAGED HEALTH CARE ASSOCIATION

PACIFIC BUSINESS GROUP ON HEALTH

THE FOUNDATION FOR HEALTHY COMMUNITIES

THE NATIONAL RURAL HEALTH ASSOCIATION

Barriers to Collaboration

BIOGRAPHIES OF SPEAKERS

CONFERENCE AGENDA.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references.

ISBN:

9786610186105

9780309184359

0309184355

9781280186103

1280186100

9780309592918

0309592917

9780585082417

0585082413

OCLC:

70772054