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HIAA and AHCPR Join Forces to Help Consumers Choose and Use Managed Care Plans
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
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
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
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)