i I Ii i@lt@ilill lilli@,@l@@t'li@i'lil@llill,,5ilill*illtlt@l Draft 5/10/71 REGIONAL IIE@DICAL PROGRAMS The initial concept of Regional Medical Programs was to provide a vehicle by which scientific knowledge could be more readily trans- fetred to the providers of health services and, by so doing, improve the quality of care provided with a strong emphasis on heart disease, cancer, stroke, and related diseases. The implementation and experience of RMP over the past five years, coupled with the broadening of the initial concept especially as reflected in the most recent legislation extension, has clarified the operational,premise on which it is based. Namely, that the pro- viders of care in the private sector, given the opportunities, have both the innate capacity and the Kill to provide quality care to all Americans. The purpose of this statement is to specify, given that premise, (1) what Regional Medical Programs are, (2) what their evolving.mission has become, and (3) the basis on which they will be judged. RMP -- The Mechanism RMP is a functioning and action-oriented consortium of providers responsive to health needs and problems. It is aimed at doing things which must be done to resolve those problems. RMP is a framework or organization wi thin which all providers can come together to meet health needs that cannot be met by individ- Page 2 ual practitioners, health professionals, hospitals and other institutions acting alone. It also is a structure deliberately designed to take into account local resources, patterns of practice and referrals, and needs. As such it is a potentially important force for bringing about and assisting with changes in the provision of personal health services and care. RMP also is a way or process in which providers work together in a structure offering them considerable flexibility and autonomy in determining what it is they will do to improve health care for their communities and patients', and how. As such, it_gives the health provid- ers of this country an opportunity to exert leadership in addressing health problems And needs and provides them with a means for doing o: so. RMP places a great corollary responsibility upon providers for t e health problems and needs which they must help meet are of concern_ to and effect all the pe ople. RMP The Mission RMP shares with all health groups, institutions, and programs., private and public, the broad, overall goals of (1) increasing avail- ability of care, (2) enhancing its quality, and (3) moderating its costs -- making the organization of services and delivery of care more efficient. Among government programs RMP is unique in certain of its salient characteristics and particular approaches. Specifically: (1) RMP is'primarily linked to and works through providers, Page 3 especially practicing health professional s; this means the private sector largely. (2) This means it is essentially a voluntary approach drawing heavily upon existing health resources. (3) Though it continues to have a categorical emphasis, to be effective that emphasis frequently must be subsumed within or made subservient to broader and more comprehensive approaches. It is these broad, shared goals on the one hand and the character- istics and approaches unique to RMP on the other, that shapes its more specific mission an d objectives. The principal of these are to: (1) Promote and demonstrate among providers at the local level both new techniques and innovative delivery patterns for improving the accessibility, efficiency, and effectiveness of health care. At this time the latter would include, for example, encouraging provider acceptance of and extending resources supportive of @iO's. (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 new kinds (or combinations) of health manpower. To do this in a way that will insure that professional, scientific, and technical activities of all kinds (e.g., informational, training) do indeed lead to professional growth and develop- ment and are appropriately placed within the context of Page 4 of medical practice And the community. At this time emphasis will-be on activities which most effectively and immediately lead to provision of care in urban and rural -areas presently underserved. (3) Encourage providers to accept and enable them to initiate regionalization of health facilities, manpower, and other resources so that more appropriate and better care will be accessible and available at the local and regional levels. In fields where there are a marked scarcity of resources such as kidney disease, particular stress will be placed on regionalization so that the costs of such care may be moderated. (4) identify or assist to develop and facilitate the implementation of new and specific mechanisms that provide quality control and improved standards of care. Such quality guidelines and performance review mechanisms will be required especially in relation to new and more effective comprehensive systems of health services. Even in its more specific mission and objectives, RMP cannot function in isolation, but only by working wi',,.Ii and contributing to related Federal and other efforts at the local, state, and regional levels, particularly state and areawide CHP activities. Moreover, to be maximally effective requires most MP supported endeavors must make adequate provision for continuation once initial Regional Medical Program grant support is terminated; that is, there Page 5 generally be assurance that the operating costs can be absorbed within the regular health-care financing system within a reasonable and agreed upon period. Only in this way can PMP funds be regularly re-invested. RMP The Measure It follows that the measure of a Regional Medical Program, reflecting as it does both mission and mechanism, must take into account a variety.of factors and utilize a number of criteria.- The criteria by which Pd/iP's will be assessed relate to (1) intended results of its Rrogram, (2) past accomplishments and performance, and (3) the structure and process developed by the RMP to date. A. Criteria relating to a Regional Medical Program's proposed 2rogram, and the intended or anticipated results of its future activities, will include: (1) The extent to which they reflect a provider action-plan of high priority needs and are congruent with the overall mission and ob ectives of RMP. (2) The degree to which new or improved techniques and knowledge are to be more broadly dispersed so that larger numbers of people will receive better care. (3) The extent to which the activities will lead to increased effectiveness of utilization and/comrnunity health facilities and manpower, especially new or existing kinds of allied health personnel, Page 6 in ways that will alleviate the present maldistribution of health services. (4) Whether health ma intenance, disease prevention, and early detection activities are an integral component of the action- plan. (5) The degree to which expanded ambulatory care and out-patient diagnosis and treatment can be expected to result. (6) Whether they will strengthen and improve the relationship between primary and secondary care, and thus greater continuity in and accessibility of care will result. There are, moreover, other program criteria of a more general character that also will be used. Specifically: (7) The extent to which more immediate pay-off in terms of accessibility, quality, and cost moderation, will be achieve by the activities proposed. (8) The degree to which they link and strengthen the ability of multiple health institutions and/or professions (as opposed to single institutions or gr6tips) to provide care. (9) The extent to which they will tap local, state and other funds or, conversely, are designed to be supportive of other Federal efforts. B. Performance criteria-will include-. (1) Whether a region has succeeded in@establishing its own goals, objectives, and priorities. Page 7 (2) The extent to which activities previously undertaken have been productive in terms of the specific ends sought. (3) Whether and the degree to which activities stimulated and initially supported by PIIP have-been absorbed within the regular health care financing system. Process criteria will include: (1) The viability and effectiveness of_an @IP as a functioning organization, staff, and advisory structure. (2) The extent to which all the health related interests, institutions and profession of a region are committed to and actively participating in the program. o: (3) The degree to which there is an adequate functioning planning organization and endeavor, developed separately or in con- junction-with CHP, at the local (or subregional) level. (4) The degree to which there is a systematic and ongoing identification and assessement of needs, problems, and resources; and how these are b,eing translated into the region's continuously evolving plans and priorities. (5) The adequacy of the region's own management and evaluation processes and efforts to date in terms of feedback designed to validate, modify, or eliminate activities.