Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. 1. Structure and Responsibility for Process of Care

04/30/1997

Existing data systems provide little insight into which health plans even operate, let alone how they do so and what this implies for the various actors in the system. Thus, a high priority for many different entities is information that would shed light on these issues and on what they mean for a diverse variety of functions these entities perform.

For example, if “health plan selection” is a key driver of competitive markets, how do consumers choose, what information do they want and get, what choices do they make, and how stable are their choices? This kind of information affects purchasers/consumers as well as providers and health plans that want to position themselves in the market. The information, typically based on market research, has implications for plans, for example, who want to strategically plan and market their products.

Similarly, there is considerable interest in knowing how managed care actually works both administratively and clinically, how this varies across systems, and how plans and providers interact with one another. There are related concerns for what managed care means for the operation of provider systems. What role do provider-sponsored entities actually play? Are primary care and specialty care roles changing? How do carve-out arrangements in managed care influence the process through which care is delivered and how coordinated is it from the point of view of health systems, the provider, or the participant? Information on all these issues can help entities understand how they and their constituencies may be affected by change or what effects can be anticipated.

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