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Health Plan Since its onset in 1993, the Penn-Ohio Health Care Alliance has grown to 14,481 covered members in cooperation with its business partner, HealthAmerica. This growth stems from the clear vision and core principles established by the Alliance and its founding members. Although many changes in health care have been observed over the past decade, the vision and mission of the Alliance have remained intact. Now, after years of successful growth, the Alliance must address a new health care environment if it is to continue to grow at its historical pace. Several market characteristics have surfaced which create this need for change including increased legislative actions and opportunities, the rapid growth in technology, and the demand for new and sophisticated health care services—all of which have increased premiums and costs in recent years. The result of these events not only threatens the continued growth of the Alliance and its partner HealthAmerica, it will also challenge the core mission and values of the organizations over the next several years. Therefore, change must be incorporated to slow and potentially reverse the progress of these inflationary factors. As partners, Penn-Ohio and HealthAmerica have a unique opportunity to create change among the four stakeholders involved in the health care delivery and financing process. These include the employer, employee, payer, and health care provider. Through a joint effort, each party can project its needs in order to attain balance within our select community. By definition, a Community Health Plan can be characterized as the planned interaction of purchasers, consumers, providers, administrators, insurers, and community influencers of health care services for the purpose of improving health status, balancing incentives and accountabilities, seeking cost and quality efficiencies, and assuring long-term commitment among the parties. This definition is not far from the original intent of the managed care industry. The Community Health Plan can provide further opportunity for long-term price stability and improved access to quality and cost-efficient care. The development of a Community Health Plan provides a unique opportunity for the Alliance in Western Pennsylvania and Eastern Ohio to create “win-win” partnerships. In the fall of 2000, the Alliance Board of Directors agreed that the initial focus for the Community Health Plan should begin with education, communication, and the promotion of wellness. As opportunities for change and collaboration are created through these initial steps of our work plan, further programs and opportunities for success will be measured and reported to the membership. |