In 1994, the Agency for Health Care Policy and Research awarded cooperative
agreements to five University-based groups to promote the establishment of
managed care Institutions and development of rural health networks. This p
aper summarizes the experiences of these rural managed care centers in the
first three years of this initiative. Key ingredients for achieving the pro
ject's goals that are identified by the project directors are reported as "
foundations" that must be in place from the outset, or "building blocks" th
at can be developed along the way. The development of information systems a
nd efforts to foster leadership in the medical community are areas in which
grant funding of this type can be most effective.