STANDARDS FOR SELECTING HEALTH PLANS

WHEREAS, the continued rise in health care costs has forced employers and employees to shift to lower-cost health plans; and

WHEREAS, over one-half of AFT members currently receive health care benefits through some type of managed care organization; and

WHEREAS, the number and percent of AFT members that will be shifted to some type of managed care plan is growing; and

WHEREAS, large private employers are moving their employees away from fee-for-service indemnity health plans to managed care; and

WHEREAS, both federal and state governments are developing plans to encourage Medicare and Medicaid eligibles to join managed care entities; and

WHEREAS, providers of medical care are merging and consolidating independent physician practices and hospitals into vertically integrated managed care systems that are geographically concentrated; and

WHEREAS, AFT locals, members and retirees are being asked to make decisions about different managed care entities without good information to discern differences among the plans; and

WHEREAS, managed care holds the potential of improving the quality of care through a focus on prevention and health promotion, coordinating care between primary care doctors and specialists, centrally held medical records, monitoring the outcomes of medical interventions and developing treatment guidelines based on the "best" treatment practices and provider credentialing and recredentialing based on board certification, utilization patterns, outcome studies and patient complaints; and

WHEREAS, managed care also holds the potential of lowering the quality of care by denying patient access to specialists, high-cost tests, and even the full range of treatment options as a way of keeping costs in check and increasing the pay of managed care providers, managers and/or stockholders:

RESOLVED, that AFT will develop health plan selection standards based on access, service to the local, financial stability and quality of care; and

RESOLVED, that AFT will use these standards to help state federations, locals, members and retirees identify and select local health plans that value improvements in access and quality of care on the same basis as cost; and

RESOLVED, that AFT will work with the NEA, other unions and consumer and provider groups to call for complete disclosure of managed care payment practices, gag rules and other contractual clauses that might constrict physician judgment or otherwise weaken the emphasis on the quality of patient care.