Hennings M N, Rosenthal D S, Connolly D A, Pollack M N, Lynch M M
Harvard University Health Services, Harvard University, Cambridge, MA, USA.
Cancer. 1998 May 15;82(10 Suppl):2026-34. doi: 10.1002/(sici)1097-0142(19980515)82:10+<2026::aid-cncr9>3.0.co;2-a.
Change created by managed care plans is producing tensions among oncology care providers, health plans, patients, and employers. Managed care plans, which now are dominant, are engendering concern among some patients and providers because those plans limit provider choice and reimbursement, as well as inject themselves in clinical decision-making. Collaborative approaches to purchasing and managing oncology service for a prepaid population should help reduce these tensions.
This article provides a case history of how Harvard University Health Services, a managed care delivery and insurance program serving the university collaborates with contracted oncology providers. The described approach defines mutually beneficial payment and shared responsibility for care in the context of patient centered values. As a part of this collaborative effort, liberal experimental treatment coverage is offered.
Patient care is improved because the flow of clinical information among caregivers is improved. When communication is more open, nurse case managers who work for the managed care plan also can arrange for covered services in a more expeditious manner.
Collaboration among health plans, oncologists, and other health care providers to provide patients with high quality, cost-effective care on a fully informed basis is challenging, but not impossible. The key is to define common ground and commitment to the needs of patients among health plans and providers.
管理式医疗计划带来的变革正在肿瘤护理提供者、健康计划、患者和雇主之间引发紧张关系。如今占主导地位的管理式医疗计划引起了一些患者和提供者的担忧，因为这些计划限制了提供者的选择和报销，还介入临床决策。为预付费人群购买和管理肿瘤服务的协作方法应有助于缓解这些紧张关系。
本文介绍了哈佛大学健康服务中心的案例，该中心是一个为大学提供管理式医疗服务和保险的项目，它与签约的肿瘤护理提供者进行合作。所描述的方法在以患者为中心的价值观背景下，定义了互利的支付方式和共同的护理责任。作为这项协作努力的一部分，还提供了广泛的实验性治疗覆盖范围。
患者护理得到改善，因为护理人员之间的临床信息流通得到了改善。当沟通更加开放时，为管理式医疗计划工作的护士个案经理也能够更迅速地安排承保服务。
健康计划、肿瘤学家和其他医疗保健提供者之间进行协作，以便在充分知情的基础上为患者提供高质量、具有成本效益的护理，这具有挑战性，但并非不可能。关键是在健康计划和提供者之间确定共同点，并致力于满足患者的需求。
