In 1992, ANA and 73 specialty nursing organizations developed and endorsed a comprehensive plan for health care reform called Nursing's Agenda for Health Care Reform. A cornerstone of the plan was the development and appropriate use of a managed care as a system that nursing called "organized delivery systems." Nursing envisioned an organized delivery system as a managed care system that would provide universal access to a defined standard package of essential health and treatment services, encompassing a balance between treatment of disease, health promotion and illness prevention. Additionally, the organized delivery system was seen as one that :

• Provides for practice arrangements with a full range of health care providers;
• Makes explicit standards for the selection of providers;
• Provides for financial incentives for individuals enrolled in a plan to use the participating providers and procedures provided for in the plan;
• Utilizes care coordinators who are responsible for guiding individuals in the plan to appropriate health care services in cost-effective settings;
• Utilizes a case manager in those instances in which care is complex, involves multiple providers, and is high-cost;
• Preempts state law and restricts states from limiting coverage because of pre-existing conditions and from limiting the type and number of providers;
• Encourages consumer participation in healthy behaviors and self-care; and
• Provides for utilization review that incorporates usage of standards for practice and guidelines (ANA, 1992, p.2).

The "organized delivery system" envisioned in Nursing's Agenda for Health Care Reform is strikingly similar to the "integrated delivery networks"described in the American Hospital Association's (AHA) 1995/1996 Environmental Assessment. However, as the AHA notes, these types of evolved systems are a rarity in today's managed care market, existing only in fully integrated markets such as Minneapolis (Gerstein, 1995).