Transferring managed care principles to VHA

Flynn K L, McGlynn G, Young G J
Record ID 31999008259
Authors' objectives:

To identify managed care principles that will help VHA improve its efficiency and effectiveness while preserving its unique mission.

Authors' results and conclusions: Managed care models appropriate for VHA share a number of principles: - organizational mission to improve the health of enrolled populations; - focus on primary care; - disease-focused integrated care strategy; - resources managed through quality management; - incentives that promote well-being of enrolled populations; - high value on evidence-based clinical practice; - evidence-based assessment of ethical impact of managed care approaches on health care delivery and outcomes. Several practices support the advancement of these principles: - careful composition of physician panels to ensure populations- needs are served; - use of primary care physicians as gatekeepers to promote adequate access to primary care and appropriate use of specialist services; - various types of utilization review and care management, including physician profiling and case management; - efforts to influence physician behavior through education, feedback, quality improvement, administrative rules, and financial incentives and penalties.
Authors' recommendations: VHA has begun to adopt managed care practices, but would benefit from explicit attention to these areas: - Ethical dilemmas associated with managed care should be addressed through population health advocacy. - Effective health care services and delivery mechanisms should be defined through technology assessment. - Explicit change management strategies are needed to implement population health, evidenced-based decision making, and other managed care strategies. - Quality management should be used system-wide to manage resources.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 1996
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Managed Care Programs
  • Primary Health Care
Organisation Name: VA Technology Assessment Program
Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;
Contact Name:
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Copyright: U. S. Department of Veterans Affairs
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.