1 i iiii, 1 !II .Nlil t, 11 til"il@lill i :i [@tm* Summary Report on RW IMTOLV -Di E-NT WITH fDIO'S Regional @$edical Programs appear to have a considerable interest in and involvement with I-P4O's already. This is based on information obtained by a recent telephone survey of the regions. (Fifty-five regions responded; Puerto Rico did not. In addition, separate responses were obtained from five of the nine California @IP areas, for a total of 60 separate responses.) @lost regions report that there has been general attention and/or con- sideration of INO's within the RNIP framework. For.exaniple: * Forty-three (43) of the 60 responses indicated sponsorship, participation, and/or conduct of seminars, panels, discussion .sessions regarding @@-.10's for RMP core staff, practicing physicians, and others. * Fort -four (44) mentioned meetinas and/or contacts with repre- y sentatiites of state or local medical societiesphospital as- sociations, or similar groups to discuss I-D,10's and related developments generally. * Fifty (SO) indicated initial consideration and/or discussion by the Regional (or Area) Advisory Group, its executive or steering committee, or another @ffl committee or task force of possible @R3 roles vis-a-vis 1-@1015. These 55 Regional -Medical Programs reported a total of 166 specific contacts and/or interactions (as of mid-April) with individuals and/ or groups interested in possibly establishing @@10's. These contacts have been with a diverse range of institutions, groups., and individuals as the table below would indicate. Table I -- RMP Contacts Re(,,arding LU,10's Kind of Institution No. Contacted Planning groups (CTIP & o they) . . . . . . . . . .32 Hospitdls . . . . . . . . . . . . . . . . . . . .27 Clinics . . . . . . . . . . . . . . . . . . . . .22 Wdical Schools . . . . . . . . . . . . . . . . .20 @ledical soc ieties (state & local) . . . . . . . .16 Individual physicians . . . . . . . . . . . . . .16 Existina group practices .. . . . . . . . . . . .10 Neighborhood health centers & other Federally-sponsored programs . . . . . . . . .10 Private insurance carriers . . . . . . . . . . . 4 Labor unions . . . . . . . . . . . . . . . . . . 2 Other . . . . . . . . . . . . . . . . . . . . . . 8 It is not possible to assess these contacts qualitatively, the extent to which they,have been significant or substantive. There was only one instance reported in which funds ($5,000) as well as considerable core staff effort had been extended in assisting with preliminary planning for an I-DIO. On the other hand, some of the contacts certainly would on the surface appear to be potentially significant. (See attaclmeiit,-Selected Contacts by RAP's Regarding Possible IM Development, which lists a representative sampling of the 166 contacts reported.) Only five regions (Central New York, Indiana, Nebraska, North Dakota, and South Dakota) reported having made no contacts. Three (California, Illinois, Maryland) reported nine or more contacts. (n-iree regions indicated that they had had such contacts but did not desire to be specific as to the number of with whom.) Table 2 -- Frequency of Contacts by @IP's 1/ No. Contacts enc 0 5 1-2 is 3-4 24 S-6 3 7-8 2 9 or more 3 One possibly interesting sidelight to this is that only three of the 22 states with restrictive legislation relating to prepaid group practice, reported no contacts. RW coordinators were asked to characterize the level of interest, movement, etc. with respect to @10's" in their regions utilizing a scale ran'ina from 9 "substantial" to "very lot%,." These responses revealed the following: 29 (48%) characterized FNT interest as "high" to "substantial"; 19 (32%) "moderate"; and 12 (20%) "low" to "very low." Coordinators also were asked to give their "best estimate of the potential rol6.of RMP in assisting in the development, promotion, and/or support of fMOls in your region durina the next 6-18 months." Based on a scale Z> ranging from "substantial" to "nil" forty-two (42) responses (70%) indi- cated a "significant" or "substantial" interest; 10 (17%) categorized it as "modest"; and 8 (13%) stated that interest was only "slight" or "nil." A final, open-ended question as to their comments and observations regarding the potential role of PM involvement in IM's more generally., did not elicit any widely shared reactions or concerns, identification of signal issues, or the like. There were some more common points by several coordinators, however. Among them: Misgivings were expressed about RNIP's-getting involved with M's, in view of resistance to the concept by some providers. 2 Others indicated that they are niovinu behind the scenes to place @IP'in a position of leadership" regarding the whole IB,10 issue. In this connection, coordinators in three regions (Bi-State, i@,lis- souri, and Texas) did not wish to specifically indicate the contacts they had made to date; and several others expressed their reluctance @to do so for fear that this might jeopardize either the position of the groups with whom such discussions have or are being held or the RAP itself. A few rhetorically raised questions as to what should be the role of RMP's with respect to the stimulation of and assistance to @M's;-- what in effect was expected or anticipated of them. Some suggested possible roles as they viewed it and referred to such things specifically as quality review, establishment of standards, and evaluation of I-BIO's. Several noted that the recent cut-backs@d funding outlook for RVIP would be a significant constraints A number observed that interest in IM's varied widely within their regions. The intent of the survey from which the above data were drawn was to pro- vide a rough, overall reading or assessment of the extent to which the Regional Medical Programs have become involved with current I-MO develop- ments. The information is as reported by the 60 regions/areas responding; and it was obtained with a very few exceptions by the ten RMP Regional Office Representatives by telephone using an interview guide a copy of which is attached. RVTS is now exploring ways in which such information, and especially that relating to specific contacts, might best be:updated periodically in order that it in turn can keep HSHiA's fDIO Clearinghouse advised on a semi- monthly basis of current RIAP developments with respect to ID40'si -Such a reporting requirement was instituted last month. 3 May 7, 1971 Selected Contacts b)r l@IP's iient Abnaki Health Council Vermont East Los Angeles Health Task Force Los Angeles, Calif. East Range Clinic, North Minnesota Health Services Corp. Virginia, Minn. Group Health Planning of Greater Philadelphia, Inc. Philadelphia, Pa. Health, Inc. Boston, Massachusetts Hough-l\lo@Tood Family Health Center Cleveland, Ohio Hunterdon Medical Center Flemington, Neiv Jersey King County Medical Society Seattle, Washington Lancaster General Hospital Lancaster, Pa. Lovelace Clinic Albuquerque., Neii Mexico Maricopa County Health Netivork Phoenix, Arizona Marshfield Clinic Marshfield Wis. Maryland Health Maintenance Committee, Inc. Baltimore, Maryland Mount Sinai School of Medicine New York, N. Y. Mountain Family Health Plan Beckley, l@T. Va. Ripler Clinic Little Rock, Arkansas San Francisco General Hospital San Francisco, Calif. Santa Fe Hospital Group Topeka, Kansas Southeast Alabama General Hospital Dothan, Alabama Tishimingo Medical Society Iuka, Mississippi United Mine Workers Pittsburgh, Pennsylvania Univ. of Illinois Medical School and Illinois Masonic Hospital Chicago, Illinois West Montana Clinic Missoula, Montana YAle New Haven Medical Center New Haven, Connecticut 4/8/71 Interview Guide Rt4P Involvement with 10101 s Region: Date: Respondent: li. Has the RMP become involved with HKO's in any way to date? Spe@ifically, has this entailed a. General ,attention and/or consideration of HMO's with the RMP frame- work. For example: (1-) Sponsorhip, participation, and/or conduct of Y-- N seminars panels, discussion sessions, or the iike re HMO's for core staff practicing physicians, or others. (2) Meetings and/or contacts with representatives y N of state or local medical societies, hospital associations, or similar groups to discuss HMO's and related developments. (3) initial consideration and/or discussion by y N the Regional Advisory Group, its executive or steering committee, or another RMP committee or task force of possible RMP roles vis-a-vis HMO'S. (4) Other (describe briefly) y N b. Spedific contacts and/or interactions with individ- y N uals and/or groups interested in possibly setting up an HRO. For each, specify: (1) Name(s): (2) Location- (3) When: (1) Name(s): "(2) Location: (3) When: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (1) Name(s): (2) Location: (3) When: - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - 2. What is your best est imate of the potential role of RMP in assisting ia-the development, promotion, and/or support of HMO's in your Region duringthe next 6-18 months? Substantial Significant Modest Slight Nil 3. How would you characterize the level of :Cnterest, movement, etc. with respect to HOM's in your Region? Substantial High Moderate Low Ver Low -2- -4. What further comments or observations, if any, do you.have regarding this matter of potential or possible RNP involvement with HMO's generally?