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EXECUTIVE SUMMARY Health reform is bringing about changes in the healthcare environment, but an equally significant transformation is occurring in science with the sequencing of the human genome and the [...]

A new study of managed care plans in eight diverse local markets reveals substantial variation in how plans ensure the coverage, delivery, and utilization of health promotion and disease prevention services. The authors examine the nature and sources of this variation, and identify implications for health benefits managers seeking to purchase prevention and wellness.

The health care dragon is merely sleeping. The actual cost of providing health care services continues to increase, and HMOs are facing a major profit squeeze. Employers should examine the financial strength of those with which they do business. This article analyzes HMO financial trends, cost data, and pricing policies and compares financially healthy HMOs with the industry average to determine what makes profitable HMOs click.

Objective. To discuss different types and forms of interorganizational linkages involved in the provision of primary care to older Americans, along with their distinguishing characteristics. Research Strategy. To take advantage of these linkage characteristics. The strategy requires a partnership with health services organizations and providers actually involved in the provision of services along with a planned sequence of activities involving hypotheses and methods development, intervention trials, and finally, demonstration and implementation. Conclusion. Because older Americans are frequent users of health services, their need for continuity and access provides an opportunity to examine changes to the delivery system and to monitor the system's capability for meeting their healthcare needs. Key Words. Interorganizational linkage, alliances, intervention trials, healthcare needs of the elderly, access, continuity of care, Mrs. Dorothy Peterson is a 72-year-old woman living in a retirement community. On February 1st, she was found unconscious in her apartment, and was taken to the emergency room of [...]

Strategic alliances have been utilized by other facets of the healthcare industry and might work for the changes that are necessary in the US Department of Veterans Affairs. An analysis of basic strategic alliance formations is provided. Utilization of each of these formations and application of them to the US Department of Veterans Affairs is also provided., Summary Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U. S. Department of Veterans Affairs (VA) healthcare [...]

The correlations between total quality management (TQM) and managed care are analyzed. It is argued that both TQM and managed care acknowledge the dynamic nature of clinical processes, the role of institutions and clinicians in process improvement and focus on the development and implementation of best practices. However, TQM differs from managed care in its ability to provide processes that involve employees in organizational change., Managed care is changing how we provide health care and how we manage health care organizations. While the advent of total quality management (TQM) in health care organizations was initially [...]

Objective. This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. Data Collection Methods. Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. Methods of Analysis. Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. Results. Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. Conclusion. Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment. Key Words. Colonic neoplasms, therapy; practice characteristics; medical decision making, Colorectal cancer, a major public health problem in the United States, is the second most common cancer and in cancer mortality is surpassed only by lung cancer (Garfinkel 1991). The [...]

Clinical trials are useful in evaluating health-care technology. The National Cancer Institute's Community Clinical Oncology Program (CCOP) is a national network of clinical trials established to reach the community were patients receive care with the latest cancer treatment, prevention and control. The ability of CCOP to contribute to patients to the Breast Cancer Prevention Trial is presented.

This article considers the potential of community-based quality improvement initiatives. Challenges facing managers as they function beyond the institution are presented along with action steps to assure the potential success of quality improvement within the larger community., The focus of healthcare in the US is gradually shifting from acute care to wellness, prevention and primary care. As this trend develops, the notion of quality improvement has great potential if applied outside the individual healthcare institution setting. In other words, interorganizational and interinstitutional cooperation in quality improvement could produce significant communitywide benefits. It also, however, presents significant managerial challenges. Two pilot initiatives are examined and an action plan is presented to guide managers in their quest to develop communitywide quality improvement initiatives of their own., Joe H. is a 28-year-old, HIV-positive electronics worker. In a two-month period in the spring of 1993 he was seen in the emergency rooms of four different hospitals in two [...]

Health care alliances enable member organizations to share risks, costs, knowledge and capabilities as well as take advantage of interdependencies to meet common objectives. Alliances are formed through joint ventures, marketing and distribution agreements, consortia or licensing arrangements. Whether lateral or integrative, alliances function according to the availability of resources which include funds, information and services.

Objective. This study examines how "strategic partnerships" between community-based consortia of oncologists and hospitals (CCOPs) and clinical cooperative groups emerge, develop, and influence patient accruals (i.e., the number of patients enrolled in clinical trials) over time. Data Sources and Study Setting. Study analyses are based on 65 pairwise relationships that 38 CCOPs established with eight clinical cooperative groups in September 1983 and maintained through February 1989. Data are drawn from grantee applications and progress reports. Study Design. The study examines how different types of CCOP-cooperative group exchange relate to one another and to CCOP patient accruals over six time points. Key independent variables include resource dependence, information exchange (i.e., meeting attendance and committee membership), and protocol exchange (i.e., the number of different protocols used). Data Collection Methods. Data extracted from secondary sources were entered in a data base. Principal Findings. The number of CCOP physicians and support staff who attend cooperative group meetings during the first two years of a clinical research partnership has a significant influence on meeting attendance and protocol use in later years. Two-thirds or more of the variance in patient accruals at each time point can be explained by the number of different protocols used and the number of CCOP representatives serving on cooperative group committees (or attending cooperative group meetings). Conclusions. The findings highlight the importance of historical relationships and anticipated resource dependence in shaping initial exchange patterns. They also suggest that strategic partnerships need to emphasize structures and processes that encourage early involvement in collaborative activities and that reward participants for maintaining high levels of interaction., In recent years, health services researchers and practitioners have noted the proliferation of "strategic partnerships" in the health services sector. These partnerships include hospital and health service alliances, organ procurement [...]