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

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20 HEALTHY COMMUNITIES provide services. Managed care organizations can play a role in health promotion and disease prevention, disease surveillance, and promoting quality. The IOM report The Hidden Epidemic: Confronting Sexually Transmitted Diseases (1996), illustrates the opportunities and problems in the relationship between health department and managed care organizations in one area (Box 4). Two recent reports (CDC and GHAA, n.d.; Joint Council, 1996) identify a variety of approaches to collaboration. More generally, a new joint initiative of the American Medical Association and the American Public Health Association is exploring new ways that medicine and public health can collaborate to improve health and health care in the United States (Reiser, 1996). BOX 4. IOM Committee on the Prevention and Control of Sexually Transmitted Diseases (STDs) The Institute of Medicine (IOM) Committec on the Prevention and Control of STDs held a workshop on November 9, 1995, to examine the role of managed care in STD prevention and control. The national movement toward managed care coupled with limited public funds for health programs will have a significant impact on the delivery of services provided by public health agencies, especially those that involve many providers and intervention points such as STD prevention and control. There are many opportunities and challenges for managed care to address STD issues effectively. Strengths of managed care organizations that are particularly appropriate for this role include (1) a population -based focus (i.e., group and staff models track disease and health trends for a population), (2) the ability to coordinate and integrate STD services into primary care, and (3) accountability to purchasers of health services. Increasingly, managed care organizations are enrolling Medicaid populations whose health care used to be provided by local public health departments. In some states, Medicaid revenues have been a major source of funding for public health clinical services. The absence of the revenues becomes a problem for local health departments as well as for community-based health clinics that have been providing services. Nevertheless, local health departments report that many persons with health insurance continue to use public health clinics, local health department STD clinics, or other clinics outside of their health plan for STD - related services. SOURCE: Presentation by Richard Brown, member of the IOM Committee on the Prevention and Control of STDs, at the February 22, 19%, meeting of the Public Health Committee; IOM (1996). PUBLIC HEALTH AND MANAGED CARE 21 Roles for Public Health Agencies With their potentially extensive knowledge of the community and its depth and breadth of experience in fields such as epidemiology and injury prevention, governmental public health agencies can play an important role with managed care organizations. The Future of Public Health's analysis implies that public health departments should work with managed care organizations, in the public interest, as part of their assessment and assurance mandate. "Their role can include everything from offering advice about data and information systems, to developing training and education programs, even to fostering an advocacy role (Box 5). In Particular, governmental public health agencies can: • provide information about the health status, risks, and determinants of communities served by managed care organizations, which is vital for raising awareness and setting priorities even if the jurisdictions of the health agencies do not correspond exactly to the population covered by the managed care organizations; • participate with managed care organizations in planning and policy development related to voluntary collaborative actions or regulatory policy development; • provide services, such as case management and enabling services, to managed care clients; and • assist managed care organizations with assurance and oversight when working with state agencies with regulatory responsibility. In carrying out the assessment function, governmental public health agencies have a responsibility to monitor the health status of managed care enrollees, just as for others in their communities. Similarly, governmental agencies must ensure that members of managed care plans have access to quality health care, and assessment results provide relevant information to carry out this function. In conjunction with managed care, these two functions are clearly interrelated and have undeniable costs. Managed care organizations can and should participate in data preparation and analysis, and their data systems can facilitate these activities. If there are to be independent checks on managed care plans' performance, these functions must, at some level, involve public health or other governmental agencies. 00 00