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Integrating alternative providers into managed care: a case study.

M Broida1

  • 1King County Medical Blue Shield, Seattle, WA, USA.

Managed Care Interface
|August 5, 1997
PubMed
Summary
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Washington State mandates health plans include alternative providers. One managed care organization (MCO) details its process for complying with this new healthcare law, integrating diverse medical professionals.

Area of Science:

  • Healthcare Policy
  • Alternative Medicine Integration

Background:

  • Growing popularity of alternative medical techniques, especially in western US states.
  • Washington State's legislative mandate for health plan inclusion of alternative providers.

Purpose of the Study:

  • To describe the practical challenges and strategies for a managed care organization (MCO) in complying with a new state law.
  • To document the process of integrating alternative care providers into existing healthcare networks.

Main Methods:

  • Case study approach detailing the MCO's compliance efforts.
  • Analysis of policy implementation within a specific healthcare organization.

Main Results:

  • The MCO encountered specific hurdles in identifying, vetting, and contracting with alternative providers.

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  • Successful integration required policy adjustments and provider network expansion.

    • Conclusions:

    • Compliance with mandates for alternative provider inclusion is feasible but requires strategic planning and resource allocation.
    • This case illustrates a model for other MCOs facing similar regulatory requirements in alternative medicine integration.