Bringing Collaboration into the Market Paradigm

Health Affairs

Volumn 17, Issue 6, 1998, Pages 128-137

  Berenson, Robert A ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMIC ASPECT; ECONOMICS; HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH INSURANCE; ORGANIZATION AND MANAGEMENT; UNITED STATES;

ECONOMIC COMPETITION; HEALTH CARE SECTOR; MANAGED CARE PROGRAMS; QUALITY ASSURANCE, HEALTH CARE; UNITED STATES;

EID: 0348136388     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.6.128     Document Type: Article

References (53)

1. This exploration does not address the activities of trade associations or other aggregations of competing organizations that work together to educate members; nor does it consider competitors' rights to petition government together, which is a right protected by the antitrust laws under the so-called Noerr-Pennington doctrine, although some of the issues raised in these areas are similar to those considered here.
2. A.C. Enthoven, "The History and Principles of Managed Competition," Health Affairs (Supplement 1993): 24-48.
3. J.C. Cantor, S.H. Long, and M.S. Marquis, "Private Employment-Based Health Insurance in Ten States," Health Affairs (Summer 1995): 199-211; and D.J. Lipson and J.M. De Sa, "Impact of Purchasing Strategies on Local Health Care Systems," Health Affairs (Summer 1996): 62-76.
4. J.C. Cantor, S.H. Long, and M.S. Marquis, "Private Employment-Based Health Insurance in Ten States," Health Affairs (Summer 1995): 199-211; and D.J. Lipson and J.M. De Sa, "Impact of Purchasing Strategies on Local Health Care Systems," Health Affairs (Summer 1996): 62-76.
5. Institute of Medicine, Medicare: A Strategy for Quality Assurance, vol. 1 (Washington: National Academy Press, 1990).
6. J.P. Newhouse, "Patients at Risk: Health Reform and Risk Adjustment," Health Affairs (Spring 1994): 132-146; and S. Shrewry et al., "Risk Adjustment: The Missing Piece of Market Competition," Health Affairs (Spring 1996): 171-181.
7. J.P. Newhouse, "Patients at Risk: Health Reform and Risk Adjustment," Health Affairs (Spring 1994): 132-146; and S. Shrewry et al., "Risk Adjustment: The Missing Piece of Market Competition," Health Affairs (Spring 1996): 171-181.
8. R.A. Berenson, "Beyond Competition," Health Affairs (March/April 1997): 171-180.
9. Ibid.
10. S.B. Soumerai and J. Avorn, "Principles of Educational Outreach ('Academic Detailing') to Improve Clinical Decision Making," Journal of the American Medical Association 263, no. 4 (1990): 549-556; and "Academic Detailing Could Reduce Overall MCO Cost," Managed Care Outlook (12 July 1996): 8-9.
11. S.B. Soumerai and J. Avorn, "Principles of Educational Outreach ('Academic Detailing') to Improve Clinical Decision Making," Journal of the American Medical Association 263, no. 4 (1990): 549-556; and "Academic Detailing Could Reduce Overall MCO Cost," Managed Care Outlook (12 July 1996): 8-9.
12. J.C. Robinson and L.P. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Spring 1996): 7-22.
13. Berenson, "Beyond Competition."
14. D. Blumenthal and C. Kilo, "A Report Card on Continuous Quality Improvement" (Paper prepared for Institute of Medicine Conference on Integrating Strategies for Quality Improvement, Washington, D.C., 30-31 October 1997); S.M. Shortell, C.L. Bennett, and G.R. Byck, "Accelerating the Impact of Continuous Quality Improvement on Clinical Practice: Assessing the Evidence" (Paper prepared for IOM Conference on Integrating Strategies for Quality Improvement); and D.M. Berwick, "Continuous Improvement as an Ideal in Health Care," New England Journal of Medicine 320, no. 1 (1989): 53-56.
15. D. Blumenthal and C. Kilo, "A Report Card on Continuous Quality Improvement" (Paper prepared for Institute of Medicine Conference on Integrating Strategies for Quality Improvement, Washington, D.C., 30-31 October 1997); S.M. Shortell, C.L. Bennett, and G.R. Byck, "Accelerating the Impact of Continuous Quality Improvement on Clinical Practice: Assessing the Evidence" (Paper prepared for IOM Conference on Integrating Strategies for Quality Improvement); and D.M. Berwick, "Continuous Improvement as an Ideal in Health Care," New England Journal of Medicine 320, no. 1 (1989): 53-56.
16. D. Blumenthal and C. Kilo, "A Report Card on Continuous Quality Improvement" (Paper prepared for Institute of Medicine Conference on Integrating Strategies for Quality Improvement, Washington, D.C., 30-31 October 1997); S.M. Shortell, C.L. Bennett, and G.R. Byck, "Accelerating the Impact of Continuous Quality Improvement on Clinical Practice: Assessing the Evidence" (Paper prepared for IOM Conference on Integrating Strategies for Quality Improvement); and D.M. Berwick, "Continuous Improvement as an Ideal in Health Care," New England Journal of Medicine 320, no. 1 (1989): 53-56.
17. Here we emphasize the role of government as regulator of private-sector activities. Government also is a major purchaser of health care services on behalf of specific groups of beneficiaries or employees. As a "value-based" purchaser working with other purchasers, government may be able to influence quality in ways it cannot do as a regulator.
18. T.A. Brennan and D.M. Berwick, New Rules: Regulation of Markets and the Quality of American Health Care (San Francisco: Jossey-Bass, 1996).
19. R.C. Derbyshire, Medical Licensure and Discipline in the United States (Baltimore: Johns Hopkins University Press, 1969).
20. I. Van Tuinen et al., Comparing State Medical Boards (Washington: Public Citizen, 1995).
21. T.A. Brennan, "The Role of Regulation in Quality Improvement" (Paper prepared for IOM Conference on Integrating Strategies for Quality Improvement).
22. C.C. Havighurst, "Forward: The Place of Private Accrediting among the Instruments of Government," Low and Contemporary Problems (Autumn 1994): 1-14.
23. G. Eads, "Collaboration in Other Industries" (Presentation at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement, Washington, D.C., 13 November 1997).
24. C.C. Havighurst and P.M. Brody, "Accrediting and the Sherman Act," Low and Contemporary Problems (Autumn 1994): 199-242.
25. Eads, "Collaboration in Other Industries."
26. P. Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982).
27. Health Care Quality Improvement Act, P.L. 99-660, Title IV.
28. Office of Inspector General, Department of Health and Human Services, National Practitioner Data Bank: Usefulness and Impact of Reports to Hospitals, Pub. no. OEI-01-90-00520 (Washington: DHHS, February 1993).
29. R.E. Oshel, "The National Practitioner Data Bank: The First Four Years," Public Health Reports (July/August 1995): 383-394.
30. S.S. Entman et al., "The Relationship between Malpractice Claims History and Subsequent Obstetric Care," Journal of the American Medical Association 272, no. 20 (1994): 1588-1591; and F. Sloan, Suing for Medical Malpractice (Chicago: University of Chicago Press, 1993).
31. S.S. Entman et al., "The Relationship between Malpractice Claims History and Subsequent Obstetric Care," Journal of the American Medical Association 272, no. 20 (1994): 1588-1591; and F. Sloan, Suing for Medical Malpractice (Chicago: University of Chicago Press, 1993).
32. In a more ambitious collaboration, plans would establish quality standards for practitioners and jointly enforce the standards by agreeing upon the designation of incompetent physicians and reporting them to licensing boards and to the NPDB, based on a clearly documented record of quality problems. Although it has a public policy appeal, this type of joint activity would almost certainly run afoul of the antitrust laws as an agreement by competitors on a common policy toward a particular supplier, in this case a physician. The boycott law is a powerful deterrent to private groups' acting as an extragovernmental agency. See C.C. Havighurst, "Collaboration to Achieve Quality Objectives in Health Care: The Antitrust Issues" (Paper presented at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement).
33. T.V. Hartert et al., "Inadequate Outpatient Medical Therapy for Patients with Asthma Admitted to Two Urban Hospitals," American Journal of Medicine 100, no. 4 (1996): 386-394.
34. M.L. Millenson, Demanding Medical Excellence: Doctors and Accountability in the Information Age (Chicago: University of Chicago Press, 1997).
35. M.R. Chassin, "Assessing Strategies for Quality Improvement," Health Affairs (May/June 1997): 151-161.
36. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators, "A Comparison of Reteplase with Alteplase for Acute Myocardial Infarction," New England Journal of Medicine 337, no. 16 (1997): 1118-1123; and J.H. Ware and E.M. Antman, "Editorial: Equivalence Trials," New England Journal of Medicine 337, no. 16 (1996): 1159-1161.
37. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators, "A Comparison of Reteplase with Alteplase for Acute Myocardial Infarction," New England Journal of Medicine 337, no. 16 (1997): 1118-1123; and J.H. Ware and E.M. Antman, "Editorial: Equivalence Trials," New England Journal of Medicine 337, no. 16 (1996): 1159-1161.
38. International Study Group, "In-Hospital Mortality and Clinical Course of 20,891 Patients with Suspected Acute Myocardial Infarction Randomized between Alteplase and Steptokinase with or without Heparin," Lancet 336, no. 8707 (1990): 71-75; International Study of Infarct Survival Collaborative Group: ISIS-3, "A Randomized Comparison of Streptokinase vs. Tissue Plasminogen Activator vs. Anistreplase and of Aspirin Plus Heparin vs. Aspirin Alone among 41,299 Cases of Suspected Acute Myocardial Infarction," Lancet 339, no. 8796 (1992): 753-770; and GUSTO Investigators, "An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction," New England Journal of Medicine 329, no. 10 (1993): 673-682;
39. International Study Group, "In-Hospital Mortality and Clinical Course of 20,891 Patients with Suspected Acute Myocardial Infarction Randomized between Alteplase and Steptokinase with or without Heparin," Lancet 336, no. 8707 (1990): 71-75; International Study of Infarct Survival Collaborative Group: ISIS-3, "A Randomized Comparison of Streptokinase vs. Tissue Plasminogen Activator vs. Anistreplase and of Aspirin Plus Heparin vs. Aspirin Alone among 41,299 Cases of Suspected Acute Myocardial Infarction," Lancet 339, no. 8796 (1992): 753-770; and GUSTO Investigators, "An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction," New England Journal of Medicine 329, no. 10 (1993): 673-682;
40. International Study Group, "In-Hospital Mortality and Clinical Course of 20,891 Patients with Suspected Acute Myocardial Infarction Randomized between Alteplase and Steptokinase with or without Heparin," Lancet 336, no. 8707 (1990): 71-75; International Study of Infarct Survival Collaborative Group: ISIS-3, "A Randomized Comparison of Streptokinase vs. Tissue Plasminogen Activator vs. Anistreplase and of Aspirin Plus Heparin vs. Aspirin Alone among 41,299 Cases of Suspected Acute Myocardial Infarction," Lancet 339, no. 8796 (1992): 753-770; and GUSTO Investigators, "An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction," New England Journal of Medicine 329, no. 10 (1993): 673-682;
41. Continuous Infusion versus Double-Bolus Administration of Alteplase (COBALT) Investigators, "A Comparison of Continuous Infusion of Alteplase with Double-Bolus Administration for Acute Myocardial Infarction," New England Journal of Medicine 337, no. 16 (1997): 1124-1130; and GUSTO III, "A Comparison of Reteplase with Alteplase."
42. Continuous Infusion versus Double-Bolus Administration of Alteplase (COBALT) Investigators, "A Comparison of Continuous Infusion of Alteplase with Double-Bolus Administration for Acute Myocardial Infarction," New England Journal of Medicine 337, no. 16 (1997): 1124-1130; and GUSTO III, "A Comparison of Reteplase with Alteplase."
43. K. Dracup et al., "The Physician's Role in Minimizing Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction: Recommendations from the National Heart Attack Alert Program," Annals of Internal Medicine 126, no. 8 (1997): 645-651.
44. A supplier of the more costly thrombolytic drug conceivably might bring a private suit alleging collusion resulting in loss of business. See Havighurst, "Collaboration to Achieve Quality Objectives."
45. M.L. Durham, "Partnerships for Research among Managed Care Organizations," Health Affairs (January/February 1998): 111-122.
46. G. Isham, "The Medical Director's Perspective" (Presentation at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement).
47. Eads, "Collaboration in Other Industries."
48. K. Ignagni, "Covering a Breaking Revolution: The Media and Managed Care," Health Affairs (January/February 1998): 26-34.
49. T. Davies, "California Cooperative Healthcare Reporting Initiative" (Presentation at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement).
50. D. Steinwachs, comments at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement.
51. Business Roundtable Health and Retirement Task Force, Quality Health Care Is Good Business: A Survey of Health Care Quality Initiatives by Members of the Business Roundtable (Washington: Business Roundtable, September 1997).
52. C. Borbas, "Healthcare Education and Research Foundation: Collaborating in Minnesota" (Presentation at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement); and R. Rowe, comments at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement.
53. C. Borbas, "Healthcare Education and Research Foundation: Collaborating in Minnesota" (Presentation at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement); and R. Rowe, comments at IOM Conference on Collaboration among Managed Care Organizations for Quality Improvement.