Collaboration Among Competing Managed Care Organizations for Quality Improvement (1999)
Chapter: Front Matter
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NOTICE: The project that is the subject of this conference summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the National Roundtable on Health Care Quality were chosen for their special competences and with regard for appropriate balance.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by The Agency for Health Care Research and Policy (Department of Health and Human Services), The Commonwealth Fund (a New York City-based private independent foundation), the National Research Council, the Department of Defense (Health Affairs), and Pfizer Inc. The views presented in this summary reflect the discussion during the conference and are not necessarily those of the agencies or organizations with which they are affiliated or of the funding organizations.
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National Roundtable On Health Care Quality
Mark R. Chassin (Cochair), Professor and Chairman,
Department of Health Policy, The Mount Sinai Medical Center, New York
Robert W. Galvin (Cochair), Chairman of Executive Committee,
Motorola, Inc., Schaumburg, IL
Kathleen O. Angel, Vice President,
Benefits and Worldwide Solutions, Digital Equipment Corporation, Maynard, MA
Marcia Angell, Executive Editor,
New England Journal of Medicine, Boston
Robert A. Berenson, Vice President,
The Lewin Group, Fairfax, VA
Robert H. Brook, Professor of Medicine and Health Services,
UCLA Center for Health Sciences, and
Vice President and Director,
RAND Health, The RAND Corporation, Santa Monica, CA
Ezra C. Davidson, Jr., Associate Dean, Primary Care, Professor and Former Chair,
Department of Obstetrics and Gynecology, Charles R. Drew University of Medicine and Science
Arnold Epstein, John H. Foster Professor and Chairman,
Department of Health Policy and Management, Harvard School of Public Health
Clifton Gaus (until 4/01/97), Administrator,
Agency for Health Care Policy and Research, Rockville, MD
Charlene A. Harrington, Professor and Chair,
Department of Social and Behavioral Sciences, School of Nursing, University of California at San Francisco
John K. Iglehart, Editor,
Health Affairs Quarterly, and
National Correspondent,
New England Journal of Medicine, Potomac, MD
Brent James, Executive Director,
Intermountain Health Care, Institute for Health Care Delivery Research, Salt Lake City, UT
Rhoda Karpatkin, President,
Consumers Union of the United States, Yonkers, NY
Kenneth W. Kizer, Under Secretary for Health,
Veterans Health Administration, U.S. Department of Veteran Affairs, Washington, DC
Gerald Laubach, Former CEO,
Pfizer Inc, New York
David McK. Lawrence, Chairman and Chief Executive Officer,
Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, Oakland
Edward Martin (Acting), Assistant Secretary of Defense for Health Affairs,
U.S. Department of Defense, Washington, DC
William L, Roper, Dean,
School of Public Health, University of North Carolina, Chapel Hill
O. David Taunton,
Private Practice of Endocrinology, Birmingham, AL
Bruce Vladeck (until 9/13/97), Administrator,
Health Care Financing Administration, Washington, DC
PREFACE AND ACKNOWLEDGMENTS
The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine (IOM). The Roundtable consists of experts, formally appointed through procedures of the National Research Council who represent both public and private-sector perspectives and substantive expertise, not organizations. The Roundtable was supported by funds from the National Research Council's Endowment, the Commonwealth Fund, the Agency for Health Care Policy and Research (Public Health Service, U.S. Department of Health and Human Services), the U.S. Department of Defense, and Pfizer Inc. In 1996, the Roundtable asked a group of individuals to advise it on aspects of quality in managed care. Because it is often believed that competition is the primary lever for improving quality, the group was interested in exploring the limits of competition and the possible value of collaboration among health plans to improve quality. Accordingly, a Steering Committee composed of Robert A. Berenson, M.D., Clark Havighurst, J.D., John Iglehart, Mark Pauly, Ph.D., Lee Newcomer, M.D., and Stephen C. Schoenbaum, M.D., planned a workshop which was held on November 13, 1997.
The conference explored potential areas for collaboration to improve quality among competing health plans within the constraints established by the antitrust laws and other legal requirements. The conference was convened to clarify what is meant by "collaboration for quality," to clarify the limits of such potential activities, and to explore ways to stimulate collaboration. Robert A. Berenson, M.D. introduced the subject, and Clark Havighurst, J.D prepared and presented a commissioned paper on antitrust concerns in collaboration. His paper is included in this summary. Charles C. Eads, Ph.D. provided an overview view of collaboration in other industries, particularly, the automotive industry. The summary describes speaker and reactor comments about antitrust and other legal barriers, and examples of collaboration in health care as well as other industries.
The conference had three sessions. The first session addressed conceptual issues. The second session was a reactor panel discussion among parties with different perspectives. The third session included real-world examples of collaborative efforts. Finally, the conference participants were invited to discuss their views and conclusions about the plausibility of collaborative efforts in health care and ways to encourage such efforts.
This summary has been reviewed according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The purpose of this independent review is to provide candid and critical comments to assist the authors and the National Academy of Sciences in making the published summary as sound as possible and to ensure that the summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The Institute of Medicine would like to thank the following individuals for their participation in the review of this document: Catherine Borbas, Ph.D.; Peter Barton Hutt, L.L.M.; George Isham, M.D.; David Nerenz, Ph.D.; and Leif I. Solberg, M.D. While the individuals listed above provided many constructive comments and suggestions, responsibility for the final content of the summary rests solely with the authoring group and the National Academy of Sciences.
CONTENTS
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Introduction to Collaboration |
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Legal Issues in Collaboration |
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Lessons from the Electronics Industry, |
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Antitrust Regulation, |
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The Limits of Competition, |
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The Medical Director's Perspective, |
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Health Care Education Research Foundation, |
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The Employers' Managed Health Care Association, |
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Pacific Business Group on Health, |
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The Foundation for Healthy Communities, |
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