An Accountable Health Plan is a joint venture between different health care parties, such as providers and practitioners. This partnership helps those involved assign and assume responsibility for delivering medical care and managing the costs of rendered medical services. AHPs may include:
- health networks
- managed care organizations (MCOs)
- integrated delivery systems (IDSs)
Anytime an independent practice association (IPA) offers more than one health insurance product, or a managed care organization expands their medical delivery capabilities, they qualify as an Accountable Health System or Plan.
All AHPs share common goals and missions. The mission of most AHPs is to promote care quality through increasing communication and collaboration between medical staff and management. This translates to member organizations systematically monitoring the quality of patient care and services. Their goal is to obtain objective data and make necessary improvements. Some organizations will implement continuous improvement plans and policies to evaluate the professional growth and competency of medical providers and office staff.
AHPs strive to ensure that members enjoy increased access to primary and preventive care services. Organizations often commit to improve their members’ health through preventative medical maintenance and ongoing educational opportunities. AHPs encourage organizations to detect and treat diseases and disorders early. They focus on educating members concerning their health plan benefits. This includes how to use the health care system. As a result, many organizations add cultural and linguistic services and introduce technology upgrades and resources.
Who Oversees AHPs?
An AHP director will implement and maintain operations that support financially healthy medical plans. They continuously evaluate benefit plans to make recommendations. For example, they may analyze population and demographic data in order to adapt benefit plans and offered services. They develop and implement strategic goals and operational objectives through establishing financial and actuarial models. AHP directors direct and oversee actuarial analysis to support:
- premium pricing budget creation
- underwriting activities
- benefit plan redesigns
They often work with organizational executives to configure:
- mandatory reporting
- benefit roles
- staff responsibilities
- care coordination standards
- disease management policies
They provide leadership by testing out new technology solutions and innovative health care services models. AHP directors develop operational mechanisms to elicit feedback on departmental and provider performances. They also seek feedback of health care consumers’ needs and satisfaction of services.
AHPs offer excellent benefits, but they also come with embedded challenges and operational vulnerabilities. In order to properly run an AHP, health care leaders and administrators must always strategically think in order to identify the root causes of problems, implement viable solutions and evaluate the long-term outcomes of solutions. ADP directors must investigate patient complaints and program deficiencies in order to improve provider engagement strategies, network utilization, referral development and overall provider adequacy.
AHPs depend on coordinating service standards and processes, so health care leaders must have expert level analytical and quantitative skills. They must excel at persuading others to approach problems differently and to use logic to identify the strengths and weaknesses of different solutions. They must be good at communicating ideas and information to professionals with high levels of medical knowledge, but low levels of financial and administrative experience.
An Accountable Health Plan is an integrated system of medical services that offers exclusive benefits to members. One of the most recognized AHP is an organization called Accountable Health Care IPA.