By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.6
Create integrated care organizations (ICOs)
Years 2–4 · UHADiscuss this step
Every concrete action this step requires, who is responsible, and when it happens relative to enactment.
| # | Action | Owner | When | Trade-off |
|---|---|---|---|---|
| 3.6.1 | Define requirements: own or employ primary care and hospital services, accept all comers in their service area, publish quality and waits. | UHA | Year 1 | Strict requirements keep ICOs genuine but exclude smaller systems. |
| 3.6.2 | Set capitation at 97% of expected UHP spending for the enrolled population (risk-adjusted), with audits of risk coding. | Rates Board | Year 2 | A 97% capitation rate guarantees savings but may be too low for systems serving sicker patients. |
| 3.6.3 | Patients choose an ICO annually; they can see non-ICO providers only for emergencies and the wait-time guarantee. | UHA | Year 2+ | Annual lock-in keeps budgets stable but limits patients' mid-year choice. |
| 3.6.4 | Prohibit ICOs from offering cash benefits, gift cards, or marketing. | UHA | Year 2 | Banning marketing prevents MA-style gimmicks but makes it harder for patients to learn about ICOs. |