Regulation of accountable health plans in rural areas.

Monitoring newly emerging "accountable health plans" is a public health responsibility related to Certificate-of-Need regulation. AHPs should use locally-based primary care providers, assure access to high quality affordable care to rural communities, contract with essential community providers, be governed by local boards of health, and report information necessary to evaluate their performance. Performance should be measured epidemiologically, using population-based rates such as infant mortality, incidence of late-stage breast and cervical cancer, and avoidable hospitalizations. Supplemental indicators include travel time to care, primary care personnel per capita, volume in volume-sensitive procedures, EMS response time, and client satisfaction.