Minnesota’s 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. This paper reviews these models post-implementation and articulates some initial conclusions about likely trends in rural CISN and health care cooperative development based on the legislative and regulatory framework established by the state as well as implementation efforts.
- CISN regulatory requirements and the pattern of CISN development suggest that local development of CISNs in rural areas of the state is unlikely to occur without the financial assistance of a large health plan or tertiary provider;
- Health care provider cooperatives appear to have more potential than CISNs for developing as locally-owned and controlled organizations in rural areas; however, cooperatives still need to prove that they can successfully negotiate contracts with health plans, implement satisfactory provider payment mechanisms, and manage risk.
- Additional public sector involvement may be necessary if locally-based CISNs, health care provider cooperatives, or alternative health care delivery and financing models are to be successfully implemented, especially in less densely populated, rural areas of the state.
- Minnesota’s experience with CISNs and health care provider cooperatives in rural areas will be of interest to policymakers considering current Medicare reform proposals.