Abstract
The authors developed a list of population-based public health competencies. They surveyed the chief executive officer, chief medical officer, and chief quality control person at a randomly selected group of managed care organizations drawn from the membership of the American Association of Health Plans. The authors asked them to rank those competencies that were essential for them in their work with their organization. The authors identified both the most commonly required competencies across all groups and the most essential for each specific job in the managed care organization. This article discusses these competencies and their implications for those who are responsible for ensuring that graduates have achieved required competencies.
MANAGED CARE IS expanding rapidly. It is likely that it will continue its expansion, particularly in public sponsored programs such as Medicare and Medicaid. With the growth in individuals covered by managed care insurance products, there has been a concomitant increase in the number of individuals employed by managed care organizations (MCOs). It is imperative that these individuals receive appropriate preparation for the job they are performing. Educational institutions should be preparing these individuals with appropriate competencies to ensure that the workforce for managed care is adequately prepared rather than depending on MCOs to do on-the-job training that might be required.
Managed care differs from traditional health insurance in that the company is taking responsibility for the health of the defined population, its enrollees. The company assumes responsibility and accountability for a defined population for which it assumes financial risk. Also, managed care plans increasingly are held accountable for their quality. For example, the Health Plan Employer Data and Information Set of the National Committee for Quality Assurance (NCQA) contains many preventive services. Thus, these services provide the measure of quality that NCQA uses for accreditation of MCOs and the quality report cards that are shared with employers and employees about their MCO. The notion of health maintenance also has resulted in those organizations providing comprehensive first dollar coverage for preventive services. Thus, they have an interest in a variety of ways of how managed care does its business. It is also readily apparent that this is a shift in paradigm for insurance companies and more closely resembles the fiduciary responsibility assumed by governmental public health agencies who are responsible for the health of a defined population, which, in this case, is the entire community. Given this paradigm shift from traditional insurance products, there is the increasing recognition that population competencies drawn from public health will be useful to the managed care workforce. In fact, some have suggested that managed care represents the intersection of medicine and public health. 1 Several articles and reports have focused on competencies needed by clinicians in managed care environments. Some even have focused on administrative and managerial educational needs of the physician executive. 2 There is little literature, however, that focuses specifically on population-based competencies likely to be taught by individuals with a background in public health. At least one monograph has focused on the competencies in public health required by managed care; unfortunately, this was the result of a focus group and was not empirically based. 3 While both are valuable contributors, they do not provide documented evidence of specific public health competencies required by the managed care work force. Such documented evidence is best provided by thoughtful outcome studies. Such studies are difficult to accomplish, so other, less direct, evidence may be helpful in this regard.
As MCOs increase their reliance on population-based skills, they will look to public health professions to assist in the acquisition of those skills. A task force of the American Public Health Association (APHA) has recommended that managed care training should be incorporated into APHA's continuing and professional education initiatives. 4 In order to address this issue, the authors undertook an empiric examination of population competencies required by MCOs. In addition to physician executive clinicians, the authors also examined the competencies required by administrators and quality assurance (QA) administrators.