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                                THE RMP  MECHANISM

               if we are to impact on the "health care crisis" by
           improving access to care  improving productivity and quality,
           and containing costs, we must have an effective mechanism
           for dealing directly with the provider community.  Without

           the provider's active participation, desirable c anges can-

           not be effected.

               RMP is a  functioning  rofessionall y acceptable link
                                    p

           between the Federal government and health care providers.

           in our opinion it can become a most important implement to

           foster constructive change.

                The past RMP record is thought by many not to have been
           satisfactory.  We appreciate that the program has lacked

           direction.  It has sometimes subsidized continuing education

           for the best paid profession.  It has often duplicated the
           efforts of local planning bodies.  It has not demonstrated
           sufficient substantive accomplishment to warrant high levels

           of continuing Federal expenditure.


                                                 Novem-Deri/, lilz

               However, despite these shortcomings, the  RMP  mechanism

           has developed and exists as a valuable asset.  It is a
           functioning link between the private sector and the  Federal

           Government.  in a system of predominately private providers,

           such linkage is critical.

               The health service provider community  must  participate

           in developing and must be willing to accept changes in  the
           delivery system.  There is no system of compulsion available
           to this government to force a privately financed,  privately
           run and privately staffed system.to undertake delivery
           system reform--nor do we advocate such compulsion.  Thus,

           we need a mechanism through which the Federal Government

           can effectively influence the health services provider

           establishment. kMP is the only such mechanism,  already  in
           place, that has been accepted by much of the provider  com-
           munity.  The system is established, does work and is reason-
           ably effective.  It would be exceedingly difficult and

           expensive to replace.

                Loss of this mechanism.,- either by-abolish-ing RMP

           altogether or by incorporating it into special health
           revenue sharing, would mean loss of effective contact  with

           the most important professional constituency the Department

           seeks to influence to improve the delivery of health  care.


                                                  Novemoer i/, ij/z

                We believe that the RMP mechanism can make a key con-

           tribution to improved health care in at least the following

           three priority areas:

                1.  Developing and implementing new and specific

                    procedures for quality assessment and assurance.
                    (Indeed it may be essential for prompt and
                    effective implementation of the PSRO legislation

                2.  Developing and implementing programs to improve

                    access to health services.

                3.  Proviaing technical assistance to implement

                    CHP-identified priority programs.

                Therefore, we believe our best approach is to clarify
           the RMP mission by changing the authorizing legislation

           to articulate these priorities.

                Attached is a paper which summarizes RMP history,

           identifies its strengths and weaknesses, and spells out some.
           important needs to which we believe RMP can respond-- needs
           which would not be met if RMP is included in Revenue Sharing.

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