HMOs in Massachusetts have agreed to voluntary guidelines on what to do for their subscribers and for nonsubscribers in their communities.
It's believed to be the first attempt in the country to establish guidelines for what HMOs should do for those in their communities who are not subscribers.
The guidelines were agreed to by the 15 HMOs in Massachusetts, Blue Cross and Blue Shield, and consumer advocates during a year of discussions with Attorney General Scott Harshbarger's staff.
They spell out what HMOs should do to improve the health of communities and access to healthcare for the underserved, including low-income and disabled people.
Nearly 2.2 million residents of Massachusetts, or 37% of the state's population, belong to HMOs.
"Given the healthcare marketplace today, the line between insurers, care providers and hospitals is becoming very blurred, and it will continue to be blurred," said Barbara Anthony, chief of the attorney general's public protection bureau.
"We're trying to provide an incentive here for HMOs to address unmet healthcare needs among both their members and nonmembers."
The guidelines also deal with ethics in pledging not to engage in advertising or marketing practices that might discourage less desirable insurance risks, such as those who are disabled or have more than average medical or social needs, from subscribing.
The HMOs also agree to ensure that "linguistic and cultural differences and physical disabilities do not present barriers to accessible healthcare."
The HMOs are to work with representatives of the communities they serve to develop ways to meet the needs of low- and moderate-income individuals and families.
Special attention is to be given to the needs of the working poor; poor children; low- and moderate-income elders; victims of domestic violence; members of racial, linguistic and ethnic minorities; and people with physical and mental difficulties.
The HMOs are encouraged to support development of health insurance coverage that anyone, whether or not a member of an employee group or someone with a pre-existing medical condition, can buy, and which subscribers can keep when changing jobs.
The Massachusetts Association of HMOs endorses the guidelines, but its director, Robert Hughes, said he doesn't expect them to make much difference.
"I don't think this was a useless process," he said. "But the attorney general began with the assumption, not knowing what we did, that we had to do more.
"I hope the plans take this as an opportunity to prove that what they are doing is really very substantial," he said.
"We can always do more to meet the healthcare needs of the underserved through language, education and accessibility," said James Hooley, chief executive of Neighborhood Health Plan.
"We welcome the efforts of the other HMOs in joining with us to improve the quality of life for those who cannot always advocate for themselves," he said.