Working Towards Health Care for All: 10 Essential Characteristics of a Cooperative
One key question lawmakers are debating in current health reform discussions is how to effectively expand coverage to more people, while also ensuring that coverage is adequate and affordable. Some policymakers believe that a public plan is the best solution — a government-sponsored program that would offer coverage alongside private organizations like Group Health. Others believe that a public option of this kind is unnecessary, that needed changes to our nation's coverage system can be forced by imposing new federal rules and regulations on the insurance market.
Also see: Health Reform Glossary of Common Terms
As the debate between these two groups has intensified over the last few months, a third path has emerged: cooperatives. Sen. Kent Conrad and some of his colleagues in both the U.S. House and Senate would like to provide federal seed funding and oversight to support the creation of new health care cooperatives at the state or regional level. Their goal is to bring health care coverage to more citizens with the benefits that member-run, efficient, high-quality systems can bring, while preserving a functioning private market that will continue to drive innovation and value.
Group Health Cooperative, as a consumer-governed nonprofit organization that provides both health coverage and care, has been held up as a model for these new entities, and we have been asked for our opinion about this proposal. We believe that no matter what health reform's approach to expanding coverage and reforming the health insurance market looks like — whether a public plan, cooperative, or simply imposing new federal rules and regulations — we can't fix the fundamental problems with health care in this country unless we also change the way health care is delivered and financed.
If health reform includes a cooperative proposal, Group Health believes there are some essential characteristics those cooperatives should have in order to successfully engage members in their health and wellness and help drive the health care system toward higher-quality, more affordable health care for all.
In our view, a health care cooperative would:
- Be a nonprofit organization, licensed to provide health insurance or health coverage under the laws of its home state.
- Be governed by its members, who would elect members of the Board of Trustees from among its membership and provide guidance and oversight to the organization.
- Work directly with organized physician medical groups so that the medical centers, hospitals, and palliative-care facilities where members receive their care are an integrated part of the cooperative, and members receive high-quality, coordinated care.
- Encourage quality and value of care — not volume — with financial incentives for well-coordinated and effective health care, and through administration and management that are held accountable as good stewards of the organization's finances and the clinical quality of its health care.
- Use health information technology tools in the care delivery system — such as electronic medical records — that provide secure e-mail between patient and provider and online access to lab results, benefits information, and prescription refills.
- Offer health coverage and care to people in Medicare and Medicaid as well as individuals and groups of employees.
- Be accredited by a major independent quality-assurance organization such as the National Committee on Quality Assurance (NCQA) to ensure ongoing, high-quality operations.
- Hold itself accountable to performance standards, and share its performance and the performance of its providers with the public.
- Have an active community presence to promote broader public health, disease prevention, and well being.
- Support unbiased public-interest research on health care systems and treatment options, with the goal of expanding the knowledge base to improve health and health care both inside and outside the cooperative.