disease reporting and inadvertently circumvent the requisite comprehensive analysis of pathogenic isolates needed for disease tracking.

Laboratory practices are also changing because fewer tests are conducted to determine new pathogens and levels of susceptibility to antimicrobial agents. Moreover, since large laboratories that are not likely to be in the same state as a patient's HMO conduct much of the laboratory testing, a widespread outbreak might not be detected through reporting by a single HMO. This situation is problematic because HMO patient databases are often uncoordinated and poorly networked, consequently making disease tracking even more complex and difficult.

The uniqueness of each managed care organization and the essential capabilities of private and public microbiological laboratories underscore the importance of working together. The challenge that lies ahead is how to plan a comprehensive infectious disease surveillance system that allows maximum coordination and flexibility for change. The opportunities are many for all parties to become involved in negotiating how the evolving health care system can improve public health.

The presentations described below examine the opportunities and challenges for academic health centers and managed care organizations to work together in the fields of basic and clinical research in addressing issues related to emerging infections.

AN EMPLOYER'S PERSPECTIVE

Presented by Thomas J. Davies, M.P.A., J.D.

Manager of Managed Care, GTE Corporation

Integrated health care delivery systems offer the greatest hope for improving quality while managing costs, including the quality and costs of infectious disease control. Employers as purchasers of health care can play an important role in determining the extent and quality of care for their employees. They can also be instrumental in helping determine how care is administered and used. Many believe that consumers, not employers, have largely driven the growth toward managed care because of their preference for the greater benefits and lower costs of HMOs. Subsequently, employers have responded in a number of ways depending on their size and their perceptions about how they can influence the delivery of health care. Small and midsize companies largely regard their role as helping to pay premiums, that is, to alleviate some of the costs of health care for the employee by arranging and paying for health insurance. Large companies, on the other hand, have unique opportunities to make more of an investment and move toward value-driven purchasing strategies, whereas smaller and midsized firms tend to choose health plans on the basis of cost. Many employers see managed care as their best hope for containing costs while maintaining



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