Managed Care Systems and Emerging Infections Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary (2000) / Chapter Skim
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2 Conducting Basic and Clinical Research in the Managed Care Setting
2 Conducting Basic and Clinical Research in the Managed Care Setting
Pages 13-24
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From page 13... ...
In recent years, academic health centers have felt the fiscal pressure of health care restructuring as managed care organizations negotiate discounted fees with the faculty practice plans and teaching hospitals that support medical schools. 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.
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From page 14... ...
The 35-year Bend in the source of revenues within academic health centers is shown in Figure 2-2. In fiscal year 1961, the United States had 85 medical schools with aggregate expenditures of $430 million (current dollars)
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From page 15... ...
However, the market-driven shift away from cost reimbursement and feefor-service revenue sources has eroded the clinical revenue margins that previously provided AHCs with substantial discretionary funds to support basic and clinical research. In addition, the ongoing transformation of health care delivery under managed care has resulted in a migration of care out of the hospital and into ambulatory-care settings.
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From page 16... ...
As such, it has become harder to perform the type of large-scale, population-based research commonly required to control emerging infections. Managed care organizations, however, have the potential to assist in these efforts with their integrated, computerized database capabilities.
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From page 17... ...
In such systems, computerized information systems are extensively used for a variety of patient care and administrative functions. The availability of computerized information covering the entire spectrum of medical care for large populations provides opportunities for many types of health research, including public health surveillance, epidemiological studies, and health services research.
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From page 18... ...
Unique advantages provided by large managed care organizations include well-defined, representative, and stable patient populations; the integration of inpatient and outpatient services within one system; centralized pharmacy services; centralized laboratory services; computerized and uniform databases, including databases containing medical, pharmacy, and laboratory records; and control of approaches to the delivery of health care at the individual practitioner level. These
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From page 19... ...
However, less than 25 such managed care organizations exist in the United States. The principal advantage of working with a research-savvy managed care organization is its ability to provide a large, well-defined, and relatively stable patient population that has uniform access to care, thereby minimizing selection bias and facilitating retention and follow-up in studies.
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From page 20... ...
Managed care organizations complain that academics want to pursue research that is not relevant to their clinical needs, that investigators fail to consult with them early in the process of designing clinical trials, that the only concern of academic scientists is access to patients, and that these researchers do not follow through clinically with the results of their studies but merely publish them in peer-reviewed journals. On the other hand, academic clinical researchers complain that HMOs are reluctant to refer patients to academic health centers because it is perceived that care is too expensive; they demand discount rates from academic health centers, which results in lost subsidies to clinical research; and in some cases, they are reluctant to pay the costs for the routine care provided in the research context.
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From page 21... ...
These are summarized below in the sections Supporting the Functions of Academic Health Centers, Ensuring Adequate Databases for Clinical Research, Exploiting the Unique Advantages of Managed Care for Surveillance and Research, and Promoting Collaboration. Supporting the Functions of Academic Health Centers The clinical revenues generated at AHCs have greatly contributed to the growth and excellence of medicine in the United States, produced outstanding basic and clinical research, promoted the training of physicians and scientists, facilitated the growth of the nation's biotechnology industry, and provided a health care safety net for those most in need.
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From page 22... ...
Exploiting the Unique Advantages of Managed Care for Surveillance and Research Some view managed care as antithetical to clinical research because priorities often emphasize rapid patient throughput, low-cost care, limited laboratory testing, quotas for numbers of patient consults per physician, and lack of reimbursement for costly procedures. The possibility that managed care organizations could improve surveillance and treatment of emerging infections was discussed at some length.
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From page 23... ...
Conversely, clinical researchers at academic health centers find that some managed care organizations are reluctant to refer patients to clinical trials and are unwilling to pay for the routine patient care provided in the research context. Close collaborations between academic health centers and managed care organizations can be achieved by (1)
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From page 24... ...
Consequently, there is an immediate need to gauge the health of the nation's public health laboratories, a topic that will be addressed in an upcoming workshop of the Institute of Medicine Forum on Emerging Infections. After this workshop was held, a new report from the Institute of Medicine examined both the evidence for extending coverage for routine care during clinical trials and the cost to Medieare of doing so.
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