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Providers are Consumers, aren't they? - March 20, 2011

posted Mar 19, 2011, 12:49 PM by Terry Shilling   [ updated Mar 19, 2011, 2:14 PM ]

Providers are the perfect Consumer Sponsor of a CO-OP

Those interested in the evolving nature of the Accountable Care Act (ACA) have been generally not quick to recognize the potential for Consumer Operated and Oriented Plans (CO-OPs). The sponsors of the ACA gave birth to the concept, funded it, and then generally left the details to others. but were not prescriptive about what type of individuals or groups would do the heavy lifting necessary to make the concept a reality.

The problem is this: most would-be members consumers lack the ability to organize themselves. In large chunks, the potential sponsor must:

  • Create a non-profit company,
  • Assess feasibility,
  • Develop a business plan, 
  • Seed the organization with money without an initial return, 
  • Shepherd a highly regulated and intricate idea through to a (hopefully successful) end.
All of this must be done in a spirit of altruism.  It seems, however, that health care providers (particularly if they are working together now in Group Practice, Integrated Systems, or ACOs) have shown just this ability to organize. 

All that leads to my main point: providers are consumers too. Providers need and manage to buy health insurance in individual and group markets for themselves and their dependents or employees. Larger provider groups tend to use ASO arrangements and thus self insure their health coverage. The ability, and perhaps need to take this ASO approach may become less clear as we move toward 2014. Thus, providers are ideally situated as the consumers described in the ACA to support a CO-OP: In fact, nothing says commitment better than consuming a product of your own making.

Terry

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