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 HMO Industry to Raise Concerns About Several Components;
 To Propose Uniform National Standards for Health Plans
 /ADVANCE/ WASHINGTON, Sept. 22 /PRNewswire/ -- Group Health Association of America (GHAA), the national trade association representing health maintenance organizations (HMOs), applauds President Clinton for his leadership in moving health care reform to center stage and placing universal coverage at the forefront of the American agenda.
 "We're delighted that the president advocates a major role for HMOs in achieving his goals of comprehensive, high-quality health care at an affordable cost for all Americans," said GHAA President Karen M. Ignagni. "HMOs provide exactly that kind of care right now, and they will rise to the challenge."
 Health maintenance organizations, which emphasize preventive care and offer comprehensive services to enrolled members at fixed fees rather than on a fee-for-service basis, currently serve about 42 million Americans -- compared to about 11 million a decade ago -- and have been at the forefront of combating the rise in health care costs and continuously improving health care for HMO members, Ignagni said.
 "HMOs offer a key element that is missing from the rest of the American health care system: coordinated care," Ignagni said. "The president encourages individuals to choose between coordinated care vs. fee-for-service plans. We support this principle, because consumers want freedom of choice and because HMOs work best when they're competing for consumers' confidence."
 Ignagni noted that HMOs are the model for many of the reforms proposed by the president. "HMOs offer a comprehensive package of benefits, low out-of-pocket costs, an emphasis on preventive and primary care, internal and external quality reviews and a commitment to consumer education and protection. HMOs have been the proving ground for reform.
 "The more tools consumers have with which to make intelligent choices, the more they will become active participants in selecting plans that provide care efficiently as well as effectively," Ignagni said.
 GHAA member plans are leaders in developing the reliable measures and data systems that will make it possible for consumers to have "report cards" on health plans and make choices based on their comparative merits, Ignagni added.
 GHAA believes the government's role in health care reform should be to support positive initiatives already underway, not to supplant the innovation that has been the hallmark of the HMO industry.
 At the same time, federal regulation is crucial to establishing uniform national standards for health plans seeking to participate in the system, GHAA believes.
 "We understand the president's desire to share responsibility for reform with the states, but providers and consumers need a level playing field," Ignagni said.
 "A system in which regulation varies from state to state will be confusing and frustrating to everyone. It could also result in different levels of protection depending on where health plans are located," Ignagni emphasized.
 GHAA is also wary of trying to contain costs by capping premiums, Ignagni said. "Our experience tells us such an approach would be hard to administer and that it is unlikely to achieve its stated goals. Our plans' experience with a flawed Medicare payment formula causes us to have concerns about systemwide use of a similar methodology," she stated.
 "Moreover, HMOs have demonstrated their commitment to providing high-quality, cost-effective care," said Ignagni. "We have been successful by coordinating the care of a defined group of people while having the flexibility to respond to special needs," she explained.
 HMOs will continue to play a major role in the policy debate. "We expect to work closely with the administration and both Democrats and Republicans in the Congress as they debate the merits of various proposals," Ignagni said.
 As the health care reform debate evolves, Ignagni added, GHAA will offer recommendations on many matters related to converting nationwide reform from theory to fact. "We may differ from the administration on some aspects of reform," she said, "but we agree with the president that universal health security and nationwide health care reform are long overdue, and we commend him for his courage and commitment to goals we share."
 Group Health Association of America (GHAA), founded in 1959, is the nationwide trade association for health maintenance organizations (HMOs). GHAA's 350-member HMOs enroll close to 32 million people, about three-quarters of the 42 million Americans receiving health care through HMOs today.
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 /NOTE TO EDITORS: Television broadcast media: a B-roll tape of generic health maintenance organization footage is available for the unrestricted use of television newsrooms./
 /CONTACT: Susan Pisano, 202-778-3245, or Don White, 202-778-3274, both of the Group Health Association of America/

CO: Group Health Association of America ST: District of Columbia IN: HEA SU: EXE

DC-MH -- DC020 -- 4698 09/22/93 12:57 EDT
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Publication:PR Newswire
Date:Sep 22, 1993

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