COLLABORATIVE APPROACHES TO PURCHASING AND MANAGING ONCOLOGY SERVICESFOR A PREPAID POPULATION

BACKGROUND. Change created by managed care plans is producing tensions among oncology care providers, health plans, patients, and employers. Managed care plans, which now are dominant, are engendering concern a mong some patients and providers because those plans limit provider ch oice and reimbursement, as well as inject themselves in clinical decis ion-making. Collaborative approaches to purchasing and managing oncolo gy service for a prepaid population should help reduce these tensions. METHODS. This article provides a case history of how Harvard Universi ty Health Services, a managed care delivery and insurance program serv ing the university collaborates with contracted oncology providers. Th e described approach defines mutually beneficial payment and shared re sponsibility for care in the context of patient centered values. As a part of this collaborative effort, liberal experimental treatment cove rage is offered. RESULTS. Patient care is improved because the flow of clinical information among caregivers is improved. When communication is more open, nurse case managers who work for the managed care plan also can arrange for covered services in a more expeditious manner. CO NCLUSIONS. Collaboration among health plans, oncologists, and other he alth care providers to provide patients with high quality, cost-effect ive care on a fully informed basis is challenging, but not impossible. The key is to define common ground and commitment to the needs of pat ients among health plans and providers. (C) 1998 American Cancer Socie ty.