These coalitions pursue a similar strategy of establishing a network of providers willing to offer discounted care in exchange for some assurance the providers will receive more patients. Coalitions and PPOs both balance various factors in establishing networks, such as access to providers, choice of providers, level of savings and quality of care. In other instances, a coalition may form with the intent of gathering a large volume of covered lives that give it leverage to purchase access to a PPO at a discounted rate. Finally, both coalitions and PPOs can offer a range of services not directly related to purchasing. PPOs may offer managed care programs such as utilization review and hospital precertification.
Some coalitions run educational programs for members and participants.
Others work with community groups to promote quality health care for members and the community as a whole. Some influence legislation at the state and local level, although representatives of health care coalitions must be aware of applicable lobbying laws and any restrictions as a condition of tax-exempt status. Whether coalitions get better rates from providers than insurance companies depends on individual circumstances. Theoretically, a coalition with a large number of participants concentrated in a small geographical area may be able to bring more covered lives to some providers than an insurance company with many covered lives spread over a larger territory. In such cases, the coalition might be able to negotiate lower fees than an insurance company.