Agenda - 03-09-1999 - III-B - Laserfiche WebLink

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2 9 HEALTHY COMMUNITIES the committee focused its report on how governmental public health agencies, especially at the state and local level, can develop partnerships with managed care organizations for the delivery of personal and population -based health services and with public and private community organizations to deal with broader concerns to advance the health of the community. Developing these partnerships, the committee believes, will be critical for advancing the health of the public and of communities in the future. PUBLIC HEALTH AND MANAGED CARE There has been substantial growth in organized health care delivery systems (which include managed care organizations) in recent years, and these developments have important implications for the health of the public. Managed care organizations are systems that are under the management of a single entity that (a) insures members, (b) furnishes covered benefits through a defined network of participating providers, and (c) manages the health care practices of participating providers. In the discussions initiated by the Public Health Committee, proponents of managed care have argued that its goals and tools are consistent with public health. Many public health professionals, on the other hand, have also expressed concerns about managed care organizations' motives and ability to deliver on their promises. The committee's view, as developed in this section, is that if the proper kinds of partnerships between managed care organizations and governmental public health departments are developed, managed care can indeed make an important contribution to improving the health of the public. The proliferation of organized health care delivery systems, which continue to provide care for an increasing number of Americans, has made it possible in some locales for governmental public health agencies to assure the provision of personal health services (which involve a one - to-one interaction between patient and provider) entirely within the private sector. How many elements of public health services private organizations can or should subsume remains unclear, but the number could be considerable. Providing care for the uninsured, however, remains a challenge; govemmental public health. departments will be ill prepared and inadequately funded to do so if no other personal services are being provided. In order to ensure that partnerships between governmental public health agencies and managed care organizations work effectively toward improving the health of the public, the committee reiterates The Future of Public Health recommendation that the function of local public health agencies should include an "assurance that high - quality services, including personal health services, needed for the protection of public health in the community are available and • EXECUTIVE SUMMARY accessible to all persons...:' This assurance function can be carried out "by encouraging other entities (private or public sector), by requiring such actions through regulation, or by providing services directly." Public health agencies can only exercise this responsibility if they are adequately staffed, equipped, and funded for this complex and demanding task and have appropriate relationships with health service providers. These activities should not be undertaken at the expense of existing essential public health services. Particular concerns arise when health departments have a dual role: direct provision of personal health services to some people and regulating private entities providing similar services to others. To improve the efficiency of all health systems, health agencies and organized health delivery systems, in conjunction with other community stakeholders, most reach agreement on their proper roles and responsibilities, which will vary by locale. Successful models of the integration of public health and managed care and of joint approaches to policy development do exist and need to be studied and tested more broadly, Most public health agencies do not currently have the full statutory and regulatory authority to ensure the accountability of the organized health delivery systems to the public. In the current regulatory structure, health care delivery systems are often regulated by insurance commissions that focus on fiscal integrity rather than on health. State Medicaid agencies, usually separate from public health departments, also typically focus on fiscal rather than medical accountability dimensions, except in states that have a quality initiative. Recognizing the clear need for financial oversight, governmental public health agencies should increase their ability to oversee health care providers, with the goal of becoming coequal partners with Insurance regulators and state Medicaid agencies, to ensure that the public's health is addressed in the regulation of public and private health care delivery systems. In many states, additional legislative authority will be needed before public health agencies can take on this role. This approach requires population -based health outcome and performance standards that can be monitored, and public health agencies should be a major contributor to the development and monitoring of these standards. The functions described in this report cannot be undertaken without properly trained professionals available to all communities. Thus, public health professionals should be trained to work with health services organizations to ensure quality personal health services In a community, as an essential element in providing for the health of the public. In addition, public health agencies should actively participate with organizations such as state health professions boards, medical schools, and accrediting bodies in planning and policy development. V �O