What We Do

Health Care Reform represents a new frontier for cooperative group purchasing, as midsize organizations in particular look for ways in which to stem the tide of rising health care costs.

Coalition purchasing, both homogeneous and heterogeneous, have become an accepted risk financing mechanism for health care risk. It has become particularly effective in the middle market where employers are not large enough to retain risk on their own. They require a pooling of risk with other insureds to achieve critical mass and stability. Different structures have evolved from a single pool to a layered approach in which most of the risk sharing occurs in the second layer. These programs combine the advantages of retaining risk with the group purchasing power for reinsurance or excess insurance.

Over the past decade, group purchasing has emerged as a viable structure in health insurance.

Our Plan

The strength of any coalition is the membership. We believe health care coalitions should consistently advance health systems to change to improve the accessibility, affordability, quality, and cost effectiveness of care.

The overarching goal of affordable care for all cannot be met without meeting the challenges of cost reduction and quality. Health care coalitions can perfectly serve in that role by forming a new coalition-provider partnership.

Case Study Coalition Health

Benefits Coalitions

Background

  • A public school health purchasing collaborative which involved more than 150 schools working together to promote a comprehensive approach that coordinates programs and policies and system changes at the individual, family, clinical, community, and school levels.

Situation

  • Largest school systems were looking to leave
  • Large insurers looking to selectively choose the best performing groups
  • Lack of data control
  • Unfair financing structure
  • Weak coalition rules and regulations
  • Broad provider network
  • Ineffective wellness program/risk management

Solution

  • New and fairer financing structure
  • Coalition uses health care dollars to control costs
  • Equitable sharing of profits
  • Coalition buys less insurance each year
  • Coalition focuses on variable costs
  • Coalition direct contracts with area providers
  • New wellness and incentive program
  • Right size risk using study grants
  • “Bad actor” groups asked to leave
  • Create a command and control center

Learn More About our Expertise in Coalition Health