SOURCE: Medica

May 11, 2005 11:20 ET

Patient Choice Insights(SM) by Medica Launches, Gives Consumers Control Over Healthcare Decisions Through Information on Quality and Cost

First Product to Combine Strengths of Medica and Patient Choice

MINNETONKA, MN -- (MARKET WIRE) -- May 11, 2005 -- Medica today announced the launch of Patient Choice Insights(SM) by Medica, an open access tiered network health plan product that ranks physicians and hospitals on quality and cost and equips consumers to take control of their healthcare decisions.

The product supports Medica's long-standing value of consumer choice. Insights members can access any provider in the network in any tier. There is no requirement to select a primary care clinic or provider and referrals for specialty care are not necessary. Members who obtain services from network providers in a lower tier are rewarded through greater overall value, lower copayments and/or lower coinsurance.

The Patient Choice program is widely recognized as the national leader in tiered networks with proven expertise in ranking providers on cost and quality. The original program, which places groups of providers into tiers, was launched in 1997.* The model has been extensively studied by academic institutions such as Harvard University, Johns Hopkins and the University of Minnesota.

With Patient Choice Insights by Medica, network providers are analyzed on cost, efficiency and quality measures and then ranked into three tiers. The lower the tier, the better the provider has performed on the measures.

Insights is the first product to combine the strengths of Medica and Patient Choice. Initially, the product will be offered to self-funded employers in the 11-county metropolitan area. Medica will make the product available to fully insured small, middle and large groups pending regulatory approval, which is expected this summer.

The product also includes access to the Hospital and Outpatient Surgery Facility Guide that assists members in making wise decisions about the hospitals and outpatient surgery facilities they choose. The guide includes an innovative Facility Pricing Catalog that shows facility pricing information for selected services at some of the area's prominent network hospitals and outpatient surgery centers. This information reflects the actual contracted facility rate on which benefits are based, rather than billed charges which are not relevant to plan participants. It is believed that this is the first time nationally that such information has been published and made available to healthcare consumers. The transparency of information allows members to see the cost implications of their choices, enabling them to better manage their healthcare expenditures. It is one of many tools that helps members make informed decisions about their healthcare.

Other online decision support tools allow members to compare care delivered by physicians and hospitals. For example, on mymedica.com members can compare the care they receive from their providers to best-practice guidelines and receive information about ways members can help improve their own care. Members also have access to a hospital comparison tool that allows them to review a hospital's performance on a variety of factors including its experience with treating certain conditions, including complication and mortality rates.

"We are very excited to bring Patient Choice Insights by Medica to market," said Ann Robinow, Patient Choice vice president and general manager. "We believe it addresses the needs of all stakeholders. It lowers costs, puts the focus on improving quality and creates price transparency in the system. Consumers have the tools to help them obtain the greatest value. Physicians and hospitals that provide the greatest value are recognized and rewarded."

About Patient Choice and Medica

The Patient Choice program helps consumers better understand the wide variations that exist in the cost and quality of healthcare. Its pioneering approach enables consumers to gauge value and make informed choices about their healthcare -- spurring healthcare professionals to compete on cost and quality and allowing employers to define and manage their healthcare costs. The program was acquired by Medica in March 2004.

Medica (www.medica.com) is Minnesota's largest HMO, largest PPO and leading non-profit and independent provider of health plans. Medica has 1.2 million members and 24,000 providers in a regional healthcare network service area that includes 98 percent of Minnesotans and a growing number of adjoining counties in Wisconsin, North Dakota and South Dakota. It opened a Duluth regional office in 1996. Medica also offers national network coverage to employers who also have employees outside the Medica regional network.

Medica has the highest accreditation status, Excellent, from the National Committee for Quality Assurance (NCQA®) for its Minnesota and North Dakota Medicaid HMO plans and commercial health plans. Medica's vision is to become the community's health plan of choice, trusted for its integrity, respected for its service, and admired for its commitment to innovation and efficiency.

* The Patient Choice care system was developed in collaboration with the Buyers Health Care Action Group (BHCAG), a prestigious group of Minnesota business leaders, and area provider nearly a decade ago.

INSIGHTS INTO THE TIERING PROCESS

Primary care providers are ranked according to cost, efficiency and quality measures that take into account their price, the price of the specialists and hospitals they use, and their ability to effectively manage patient care; especially for chronically ill patients. Consumer-friendly information is made available to help individuals compare factors of most importance to them and select providers accordingly.

Specialty care providers with competitive prices are placed into Tier 2 ($$). Specialists with competitive pricing, who also have incorporated an infrastructure and/or special programs that can be expected to lead to improved quality and better patient care, are moved to Tier 1 ($). Those with higher pricing are placed in Tier 3 ($$$). Higher-priced specialists with demonstrated capabilities to deliver improved quality and resource use are considered for Tier 2 ($$).

Hospitals and other outpatient facilities are tiered on their pricing for specific procedures and admissions, combined with their performance on 30 nationally accepted quality standards (as identified by the Leapfrog Group and National Quality Forum) including the sharing of diagnostic and care information with all of a patient's healthcare providers, evaluation of patients regularly for risk of complications, and a computerized prescription order entry system. Further, the Pricing Catalog includes information about the facility costs at various hospitals and outpatient facilities for specified procedures.

NOTE: A PDF file of the Hospital and Outpatient Surgery Facility Guide is available upon request.

Medica® is a registered service mark of Medica Health Plans. "Medica" refers to the family of health plan businesses that includes Medica Holding Company, Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company, and Medica Self-Insured.

Contact Information

  • For more information, contact:
    Greg Bury
    Medica
    (952) 992-8437
    Cellular: (612) 810-4556
    greg.bury@medica.com