Ensuring Quality Health Care
Private & Public Purchaser Strategies
Presenters:
Michael Bailit, M.B.A., President, Bailit Health Purchasing, LLC, Needham, Massachusetts, and former Assistant Commissioner for Benefit Plans for the Commonwealth of Massachusetts.
Patricia Drury, M.B.A., Director of Quality Measurement and Consumer Information, Buyers Health Care Action Group, Bloomington, MN.
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This session provided examples of innovative strategies that health care purchasers have pursued in
an effort to obtain quality health care services.
Massachusetts
The first example focused on Massachusetts
Medicaid, describing Medicaid's approach to contracting with managed care organizations as data driven and
placing a heavy emphasis on quality improvement. Among the tools that the Commonwealth used
to implement this approach were:
- Detailed contractual purchasing specifications.
- The identification of clear performance improvement goals.
- The establishment of joint workgroups and periodic meetings between the Medicaid agency and
managed care organizations.
Also discussed was the Commonwealth's involvement with the Massachusetts Health Care
Purchaser Group, emphasizing that the common interest that private and public purchasers had in
working together was to ensure that they received value for their health care dollar.
Minnesota
The second example focused on the Buyers Health Care Action Group (BHCAG), a coalition of large
purchasers in the Minneapolis/St. Paul area, which is a market dominated by a small number of very
large managed care organizations. Described were BHCAG's efforts to increase value, choice, and
accountability in that marketplace by bypassing the managed care organizations and contracting
directly with care systems established by groups of providers. The rationale behind
this strategy and its anticipated benefits were presented, as well as the initiatives' features with respect to
reimbursement, risk adjustment, and Employee Retirement Income Security Act (ERISA)-related issues.
Also discussed were a number of
quality-related measures—including providing financial incentives for strong performance in
certain areas—and BHCAG's plans for expanding the initiative into rural areas.
Reference
Effective Health Plan Purchasing and Management Strategies, Bailit Health Purchasing, LLC, 1996.
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