Step Seven: The purchasing cooperative could, under our hypothetical plan, enter into an exclusive capitated contract with the community-based "Rural Accountable Health Plan
" that might be named the "Milbank-Sisseton-Webster Community Health Plan," which in turn would accept the risk for providing the package of basic benefits to the "community's" 30,000 residents.
In a "managed competition world," the three parties would work together, ideally cooperatively, in a local community as an accountable health plan
. The plan would compete against one or more similarly structured plans.
The alliances would provide oversight to a number of accountable health plans
(AHPs) that would actually provide the health care services to the public.
Under the current White House proposal, "regional health alliances" will contract with "accountable health plans
" to provide "comprehensive benefit packages." The accountable health plans
, which can be for-profit corporations, will be oriented to provide services at the lowest cost in order to maximize their profits, ie, the difference between the federal caps and the corporations' expenses.
Managed competition involves the organization of the health care coverage system into "Health Alliances" and "Accountable Health Plans
." Health Alliances are "super-sized purchasing cooperatives" which will represent large, diverse groups of enrollees in buying health insurance from Accountable Health Plans
or "supersized HMOs." This system would link large numbers of individuals with networks of nearby medical facilities and providers.
Health plans (also known as accountable health plans
But be careful, because HIPCs "only market standardized benefit packages offered by accountable health plans
." But accountable, you ask, to whom?
Reform plans being considered by the White House and others would create integrated networks of physicians, hospitals, insurers, and other health providers known as accountable health plans
The processes, tools, and measures described here will become commonplace in integrated managed care systems and accountable health plans
. These processes, tools, and measures will meet the increasing expectations of individual employers, local employer health care coalitions, and the Health Plan Employer Data and Information Set (HEDIS) and the increasing requirements of accreditation bodies such as the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
If managed competition is to be the vessel of health care reform, then "accountable health plans
" (or AHPs) should lower the high deductibles that effectively eliminate coverage of primary care and preventive services under many current insurance plans, Dr.
Of the many health care reform proposals presently before Congress and state legislatures, none has received as much attention as the concept of "managed competition." Under this concept, quasi-governmental buying groups called Health Insurance Purchasing Cooperatives negotiate rates with Accountable Health Plans
(AHPs), groups of linked insurers and providers that offer basic benefit packages for capitated rates.
Sokolov, MD, who founded and heads Advanced Health Plans Inc., Los Angeles, Calif., predicted that accountable health plans
(AHPs) will be mandated this year and implemented in 1996.