. corrected Version 6 30/71 P,EGIOIZAL l@'LEDICAI, PROGRL.,IS The initial concept of Pegional L@ledi.cz,.l Programs i-7as to p@ovide a vehicle by which scientific l@no-4ledge could be mo re readily triins- ferred to the providers of he&itli services and, by so doing, improve' the qtiality of care providc-d with a strong err@phasiB on heart diiiea,,,@, cancer, stroke, and related diseases. The iirDI.eLientatlion and experience of PI,ILP over the past five years, co-,ipled with the broadening of the initial concept especially as reflected in the -LLost recent legislation extension, clarified the operational pre:nise on which it is b@-ised namely, that the pro.- vi ders of care in the private sector, given the )pport-,i@iiti--s, hlva both the inna,L-e capac4.ty and the will, to provide quality c@i,-c to i.11 k.nericans. Given this Rrer,.iise,- the purpose of than,, st@atem,-,nt I.!-, to i,@pecif-, (1) i..lli&t Regional LNI,edical Progrr. s -re, i-71iit their evolving miori.or, has beco:nE!, and the basis on x,,hich they %@ill be judged. ship -- The IIL,AP is a ftinctio;,@in,, ni-,el P..,cric@n--ori.r@nted corsoi.-titi,.n of providers responsive to health iicco's and Jt is 'It C30ir;iy tilill@r',S w',ii(.,Ii trust be to resolv(-, c@r wl)ici-i cai7t Page 2 ofesbionals, hospitals and other insti- ual practitioners, health pr tutions acting alone. It also is a structure deli-berately designed to take into acc'ount local resources, patterns of practice and referrals, And needs. As such it is a potentially important force for bringing about and assiotitio with cliant,,,es in the provision of personal health services and care. PJ.IP also is a way or process in which providers work together in a structure which offers them considerable f legibility and auton- o,.ny in determine that it is they will do to improve health care for their communities and patients and how it is to be done. As such, it given- the lieal tli providers of this country an opportunity to exert leadership in addressing health problems -.irid needs and provides them with a means for doing so. ILI-F@P places r. creat corolle.,-y respoiisibi ity,,upon providers for the health problems and needs which they rjiulst help meet are of concern to and affect all the people. PJAP -- The YLission IU4P sliarIes with all health groups, institutions, and programs, ,private and public, the broad, overall goals of (1) increasing avail- ability of caret (2) enhancing its quality, and (3) moderating its @--.costs -- malting the organization of services and del.ivery of care more efficient. Among governm@cAt progruns unique in certai.ii of its@ s.alient Page 3 (1) RMP is primarily linked to and works through providers, especially practicing health professionals this means the private sector largely. (2) '104,P essentially is a voluntary approach drawing heavily upon existing health resources. (3) Though W@P continues to have a categorical emphasis., to be effective that emphasis frequently must 'be subsumed within or made subservient to broader and more comprehensive ap- proaclies. It is these broad, shared goals on the one hand and the character- istics and approaches unique to r@1,P on the other, that shape its more. specific mission and objectives. The principal of these are to: (1) Pro.Tote and demonstrate n-raoig providers at the local leve both new techniques and innovative delivery patterns for improving the accessibility, efficiency, and effectiveness At this time the latter would include, for of health care. example, encouraging provider acceptance of and extending resources supportive of 13,ealth Maintenance Organizations. (2) Stimulate-and support those activities that will both help existing health manpower to provide more and better care and will result in the more effective utilization of neiq kinds (or combinations of health manpower. Further, to do t is in a way that will insure that professional, scientific, and technical activities of all I,,indz; inforniation,-3 1, training) do indeed lead to [)i-o.L'o@;@ionzil @,1'0@,,Lil aiCi nient and are appropriately placed iqj-tiii.n ti-io, context of ]',age 4 medical practice and the co=unity. At this time emphasis will be on activities which most effectively and itr@aedi,itely lead to prc>-iision of care in urban and rural areas presently underservc-!d. (3) Encourage providers to accept and enable them to initiate regionalizption of health fadi I.ities, manpower, and other resources so that more appropriate l,nd better care will be -P.ccessible el-Ld available at the local and regioial levels. In fields where there are'marked scarcities of resources, such as kidpey disease, particular stress will be place on regionalizati.on so that the c6sts o.f such care may be moderated. (4) identify or assist to develop and facilitate the implemen- tation of new o.-id specific @qechani-s,--s that provide quality control and improved standards of ctre. Such quality guidelines and performance review Mechanisms i-iill be require& especially in relation to new and L@-,ore effective comprehen- sive systems of health services. Even in its more specific mission and objectives, @N-,P cannot function in isolation, b-,it only by wcrl,,ing with and coiicrib'Ltting to related Federal and other efforts at the local, state, and re@,ional levels, particularly state and arerwide Coiipreliensive Ileoltil Pi;annir%.c7 activities. Moreover, to be effective recixi,"rcc, tlint I-,lost endeavors SiLipp'--)rt 5 Regional Medical Program grant support is terminated; that is, there lly must be assurance that future operating costs can be genera absorbed within the regular health care fitiancing system within a reasonable and a-reed upon period. Only in this way can IT@-IP funds be regularly re-invested. RYP -- The Measure It follows that the measure of a Regional @ledical Program, reflecting as it does boLli mission and mechanism, must take into account a variety of factors and ut2LIize a number of criteria. The criteria by which r@@'Ll's will be assessed relate to (1) intended results of its orinance, and (2) past acco,,-Apl4slirz,.ents -nd perf (3) the structure and DtOCeSS developed by the PNIP to date. A. Criteria relating to a Regional Medical Prograrn's pro?csed @o@rt,fn -ind the intended or anticipated results of its future activ- ities, will incrLtde: (1) The extent to which they reflect a providet- action-plan of high priority needs and are con-ruent with the overall. mission and objectives of (2) The degree to which new or improved techniques and kno@,71 edge are to be more broadl.y dispersed so that larger nu,,t@bers of peopl.e will receive better care. (3) The extent to which the activities ,ii.11 leid to increased utilization and c-ffeet@i.vcyio-s of cor,.ii,,,.Linity Health facilities and espcci.'-,]."Ly new or lii,cLs Of @il,],i.CCI Pai;e 6 personnel, in %;;,;yc, that will alleviate the present-maldistri- butio.i of health services. (4) Whether health i-a@,intenance, disease prevention, and early detection activities are iiit:e-zral components of the action- plan. (5) The degree to v,,-iicii expanded ambulatory care and out-patient diagnosis and treatment cc-,i be expected to result. (6) Whether they will strengthen and improve the relationship between primary P-:id secondary care, thus resulting in greater continuity and accessibility of care. There are, moreover, other pro-ra-A criteria of a more general character that also will be used. Specifically: (7) The content to w'lic'.. more ic---@@dLate nay-o4@f in terms of accessibility, quality, and cost moderation, will be achieved by the activities proposed. (8) The degree to i,7.)icli they Iii,K and streii,-, 'then the ability of multiple health institutions'zip,@,/or professions (as opposed to single institutions or groups) to provide care. (9@ The extent to which they will top local, state nnd other funds or, conversely, are designed to be supportive of other Federal offo,-rts. B. Perforr:iance criteria will in--]-itdc: (1) Whether i region has succeeded in its oi,,n gotils, objectives, zed Page 7 y undertaken have (2) The extent to which activities Previous' been productive in terms of the specific ends souaht. es stimulated and (3) V-Iiiether and the degree to which activi-ti supported by Ri@iT have been absorbed ,71.thin the initially regular hea,ltli care financing system. C. Process criteria will include: (1) The viability and effectiveness of an R%iP as a functioning organization, staff, and advisory structure. (2) The extent to which all the hetI.th related interests, institutions and Professions of a reg4@on are cor@"-iitted to ipatiriF, in the pro@,r@, And actively partic (3) The degree to which an adequate fun6t,!@@, ing planning organization a-,id endeavor has.beefi developed i-n conjunction wi-th CIIP at the local (or Slibregional) level. (4) The degree to which there is a sysL cruatic and orgoing identification and assess@,-:icnt of -needs, problems, and resources; and how these ere being translated into the regiorl's continuously evolving plans and priorit es. (5) The adequacy of the resiL-,i's own ttil(i evaluation, processes and efforts to date in terits of feedbacl@ desigAed -validate, raQ@ify, or eliminate' activities.