Guidelines for Managed Care

The WSMA supports physicians in recognizing and dealing with both the positive and negative aspects of managed care in order to promote the best possible balance of interests between patients, physicians, and delivery systems. In adopting the following guidelines, the WSMA:

1. Supports a medical marketplace that allows for experimentation and innovation, and choice for the consumer.
2. Supports a consensus model of managed care that includes the following elements:
1. Medical decision-making focused at the physician/patient level.
2. The widespread sharing of clinical and utilization information among physicians to assure efficiency, effectiveness and continuous quality improvement.
3. Practice guidelines incorporated to foster a uniformly high standard of care.
4. The management of effective delivery of health care services through maintaining the primacy of the physician/patient relationship in the entire process.
5. Control health care costs by reducing or eliminating unneeded and/or ineffective services.
6. Simple and straightforward administrative procedures for patients and physicians to improve patient relations, reduce costs, and free physicians from burdensome paperwork.
7. Integration of computer technology to support individual clinical practice and administration.
8. Local arrangements to minimize unnecessary care, fairly compensate physicians, and share risk and reward.
9. Continuing patient education concentrated on those health care areas that promise the greatest health gain.
10. Increased communication among providers and purchasers to resolve quickly those issues that add indirect costs.
11. Disclosure to all health care plan participants regarding limits of plan, financial incentives which may limit care, and means to appeal.

(EC Rpt H, A-95) (Reaffirmed A-17)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services