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Corrected Version 6/30/71

REGIONAL MEDICAL PROGRAMS

The initial concept of Regional Medical Programs was to provide
a vehicle by which scientific knowledge could be more readily trans- -

ferred to the providers of health services and, by so doing, improve

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the quality of care provided with a etrong emphasis on heart disease,

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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 onportunities, have

both the innate capacity and the will to provide quality care to all

Americans.

Given this premise, the purpose of thie statement is to gpecily
(1) what Regional Medical Programs are, (2) what their evolving mission

has becone, and (3) the basis on which they will be judged.

EMP -- The Mechanism

 

RNP ig a functioning and action-oriented consortium of providers
responsive to health needs and problems. Jt is aimed at doing things

which must be done to resolve those problems.

RMP is a framework er oreanization within which all providers

ith weeds that cansor be set by Individ-

1

can come tCepetner te meet he

oa
 

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ual practitioners, health professionals, hospitals and other insti-
tutions 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 which offers them considerable flexibility and auton-
omy in determing what it is they will do to improve health care for
their communities and patients, and how it is to be done. As such,
| it gives the health providers of this country an opportunity to exert
leadership in addressing health problems and needs and provides them
with a means for doing so. REP places a great corollary responsibil-

ity, upon providers for the health problems and needs which they must

help meet are of concern to and affect all the people.

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RMP -- The Mission

RMP shares with all health groups, snstitutions, and programs,
_private and public, the proad, overall goals of (1) increasing avail-
ability of care, (2) enhancing its quality, and (3) moderating its

~eosts -- making the organization of services and delivery of care

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more efficient. ie

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Among, government programs RMP-is unique in certain of its salient

characteristics and particular approaches. Specifically:
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(L) RMP is primarily linked to and works through providers,

especially practicing health professionals; this means the

 

private sector largely.
(2) ‘RMP essentially is a voluntary approach drawing heavily ‘

upon existing health resources.

a
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(3) Though RMP continues to have a categorical emphasis, to
be effective that emphasis frequently must be subsumed within
or made subservient to broader and more comprehensive ap-

proaches.

It is these broad, shared goals on the one hand and the character-
istics and approaches unique to RMP on the other, that shape its more,
™ specific mission and objectives. The principal of these are tot
(1) Promote and demonstrate among providers at the local level
both new techniques and innovative delivery patterns for
1improving 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 Health Maintenance Organizations.
(2) Stimulate and support those activities that will both help
existing health manpower to provide more and better care anu
will result in the more effective utilization of new kinds
(or combinations) of health manpower. Further, to do this
in a way that will insure that professional, scientific, and
technical activities of all kinds (e@.8., informational,
training) do indeed iead to professional growth and develop-

ment and are appropriately placed within the context of
medical practice and the community. At this time -

emphasis will be on activities which most effectively and-

 

imuediately 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 facilitics, 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 marked scarcities of resources,
such as kidney disease, particular stress will be placed on

regionalization so that the césts of such care may be |
moderated,

(4) Identify or assist to develop and facilitate the implemen-
tation 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 comprehen-
sive systems of health services.

Even in its more specific mission and objectives, RMP cannot
function in isolation, but only by working with and contributing to
related Federal and other efforts at the local, state, and regional
levels, particularly state and areawide Comprehensive Health Planning

activities.

Moreover, to be maximally effective requires that most RMP-~supsrorted

endeavors make adequate provision for continuation support oace initial
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Regional Medical Program grant Support is terminated; that is, there
generally must be assurance that future operating costs can be
absorbed within the regular health care financing system within a
reasonable and agreed upon period. only in this way can RMP funds

be regularly re-invested,

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RMP -- The Measure

It follows that the measure of a Regional Medical Progran,
reflecting as. it does both mission and mechanisn, must take into
account a variety of factors and utilize a number of criteria. The
criteria by which RMP's will be asseesed relate to (1) intended
results of its program, (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 propcesed

program, and the intended or anticipated results of its future activ-

ities, will include:

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(1) The extent to which they reflect a provider action-plan of
high priority needs and are congruent with the overall
mission and objectives of RM

(2) The degree to which new or improved techniques and knowledgeé
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

utilization and effectiveness of community health facilities

and manpower, especially new or existing kinds of allied healca
 

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&)

(G)

(6)

personnel, in ways that will alleviate the present. maldistri-
bution of health services,

Whether health néintenance, disease prevention, and early
detection activities are integral components of the action-
plan.

The degree to which expanded aubulatory care and out-patient
diagnosis and treatment can be expected to result.

Whether they will strengthen and improve the relationship

between primary end Secondary care, thue resulting in greater

continuity and accessibility of care.

There are, moreover, other progrem criteria of a more general

“character that also will be used. Specifically:

7)

(8),

B.

(1):

The extent to which more irzediazte pay-off in terms of
accessibility, quality, and cost moderatioa, will be achieved
by the activities preposed.

The degree to which they Link and Strengthen the ability of
multiple health institutions ‘and/or professions (as opposed
to single institutions or groups) to provide care.

The extent to which they will tap local, state and other
funds cr, conversely, are designed to be supportive of

other Federal efforts.

Performance criteria will include:

Whether a region has succeeded in establishing its own goals,

objectives, and prisrities,
 

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(2) The extent to which activities previously undertaken have

(3)

(1)

(2)

- @)

(4)

(5)

been productive in terms of the specific ends eought.
Whether and the degree to which activities stimulated and
initially supported by RMP have been absorbed within the

regular health care financing system.

Process criteria will include:

The viability and effectiveness of an RMP as a functioning
organization, staff, and advisory structure.

The extent to which all the health related interests,
institutions and professions of a region are comaitted to
and actively participating in the program.

The degree to waich an adequate functioning planning
organization and endeavor has been developed in conjunction
with CHP, at the local (or subregional) level.

The degree to which there is a systematic and ongoing

*

identification and assessment of needs, problems, and

resources; and how these ere being translated into the
region's continuously evolving plans and priorities.
The adequacy of the region's own management aud evaluation

processes and efforts to date in teriss of feedback designed

 

to validate, modify, or eliminate’ activities.