They also have an ongoing relationship, and tend to be there for handling grievances. My best example was being shown a 20-page fax of medical claims that the broker was then expected to figured out. We found that in several of our sites, purchasing cooperatives had first hoped to bypass brokers and save the cost of the brokers' commission. They quickly had to reverse themselves and bring brokers back into the picture. One association in the Boston market had its membership triple in the last two years after bringing in outside brokers.
Operational issues can also affect whether brokers bring clients into a purchasing cooperative.
Now, for health plans, it's another story. For health plans purchasing pools can be a plan's worst nightmare. Purchasing cooperatives typically have a social mission of extending coverage to those who have difficulty obtaining insurance. Given that social mission though, when they find that they achieve it, they may be also fueling the adverse selection because they're attracting these higher risks. In the issue brief in your packet, I describe the Florida cooperative and Cleveland's Council of Small Enterprises.