Press Release Date: August 28, 1995
Responding to the rapid changes in health care delivery, the Agency for Health Care Policy and Research and the Health Insurance Association of America have announced a partnership to help consumers understand how managed care plans work, and how to make informed decisions when choosing and using health plans.
Under this partnership, AHCPR and HIAA will develop a new publication for consumers who have a wide range of health care options as well as those already enrolled in a managed care plan. The brochure—scheduled to be released this Fall—will also help current managed care subscribers to better understand managed care principles, plan flexibility, and access to physicians.
"Managed care can be an efficient, cost-effective way to provide health care. However, consumers need information to better understand how managed care differs from traditional fee-for-service insurance and to choose coverage best suited for their health and personal needs," said AHCPR Administrator Clifton R. Gaus, Sc.D. "Through this timely partnership with HIAA, we can reach potential and current managed care consumers who most need this information."
"HIAA is an ideal partner for this project, and we welcome this opportunity to help consumers learn more about managed care health plans," observed Bill Gradison, HIAA president. "In order to choose sensibly, consumers should have at their disposal information about managed care plans, such as the types of benefits they emphasize and how they differ from other available health care choices.
Largely in reaction to spiraling costs, managed care is becoming the most prevalent kind of health care delivery. The number of Americans in some type of managed care arrangement is rising fast, from 15 million individuals in 1984 to more than 75 million today. Said Dr. Gaus, "Today consumers must choose among seemingly complex managed care plans and consider coverage, cost, selection and access to health care providers, and other provisions. In making this guide available, AHCPR and HIAA hope to improve the quality of these consumer choices, and to encourage consumers who participate in managed care to effectively use health services, including important prevention services."
According to Gradison, "Managed care networks vary greatly in structure and in how they deliver care, so it is very important for consumers to understand these differences. For example, some managed care plans provide a lot of flexibility and allow consumers to go outside the network to receive care. Other plans provide coverage through a network of affiliated physician groups and hospitals, while others hire doctors who work as salaried employees."
The creation of the managed care guide is part of AHCPR's efforts to empower consumers to take a more active part in their health care. To date, AHCPR has distributed almost 9 million consumer guides on common major health disorders. These guides complement clinical practice guidelines developed by AHCPR-sponsored private-sector panels for use by health care practitioners.
Although managed care is the fastest growing type of health care delivery system, little is known about the long-term effects of managed care on access, cost and quality of care. For this reason, in addition to providing information about how managed care plans work now, AHCPR also supports research on how differences in managed care types affect health outcomes, hospital stays and beneficiaries' access to health services.
HIAA is the nation's leading trade association for the private health insurance industry and represents approximately 215 private health insurance carriers and health maintenance organizations (HMOs). In addition to representing its membership before federal, state and local legislative and regulatory bodies, HIAA sponsors and produces numerous research materials about the health insurance industry and maintains an active education program for industry professionals.
AHCPR is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost and broaden consumer access to essential services. AHCPR's broad programs of research, clinical guideline development and technology assessment bring practical, science-based information to health care practitioners and consumers.
Under this public-private partnership, AHCPR and HIAA will participate in writing, printing and distributing the guide free of charge to consumers, health organizations and insurers nationwide.
For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864; or HIAA, Judy Finney at (202) 824-1786.
Internet Citation:
HIAA and AHCPR Join Forces to Help Consumers Choose and Use Managed Care Plans. Press Release, August 28, 1995. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/hiaa.htm