Patient Choice honored for innovative tiered network methodologyMINNEAPOLIS, Dec. 21, 2005 — The National Business Coalition on Health (NBCH) has recognized Medica, in conjunction with United Behavioral Health (UBH), and Patient Choice, with two eValue8™ Innovation Awards. Medica/UBH was recognized for its Private/Public Partnership to Improve Outcomes and Reduce Costs for High Risk Behavioral Health. Patient Choice received an award for its pioneering approach to value-based purchasing that leverages employer/provider collaboration, and a provider bidding process to create an innovative open access tiered network. Patient Choice is a business segment of Medica.
The awards were given to Medica and Patient Choice at the NBCH’s 10th Annual Conference in Scottsdale, Arizona. Over 100 programs were submitted for consideration and 12 were selected as finalists for the awards based on information submitted on "Best Practices and Innovations" as part of NBCH's 2005 eValue8 submission tool. The finalists were reviewed by a panel of judges from the Centers for Disease Control and Prevention, The Leapfrog Group, George Washington University and the Buyers Health Care Action Group. Based on creativity, effectiveness and the ability to be replicated, three winners were selected.
“These awards recognize programs that are successfully addressing complex health care challenges in a unique way,” said Carolyn Pare, CEO, Buyers Health Care Action Group. “Employers can directly benefit from these kinds of visionary programs and it is very exciting that two of the three programs honored this year were developed by organizations in this community.”
“Medica is honored to receive these awards not only for the recognition that comes with them but, more importantly, because they highlight the value we place on collaboration,” said Charles Fazio, M.D., chief medical officer for Medica. “They demonstrate what we can accomplish by working with employers and providers to address both clinical needs and cost issues that ultimately benefit patients.”
The Medica/UBH behavioral health program was a pilot in St. Louis County, Minnesota, utilizing a public/private collaboration to assess the needs of individuals with both a serious mental illness and substance abuse conditions. Through this program, people receive care in their community, close to home, along with education and other tools for their families and service providers. The program resulted in improved access to crisis services and effectively provided longer-term support for high-risk individuals with these co-occurring conditions.
These interventions also resulted in significant reductions in hospital utilization for all covered lives in St. Louis County at the end of the first year. For example: the admission rate per 1,000 was reduced by 7.3 percent; the readmission rate was reduced by 45.3 percent; the average length of stay dropped by 14.2 percent; and inpatient days per 1,000 fell by 20.6 percent. Because of the success of the program, it has since been replicated in six counties in the Twin Cities metro area and in four counties in Central Minnesota.
The Patient Choice open access tiered network ranks physicians and hospitals on quality and cost and equips consumers to take control of their health care decisions. Network providers are analyzed on cost, efficiency and quality measures and ranked into three tiers. Consumers who obtain services from providers in a lower (or better) tier generally have lower copayments and/or coinsurance.
The Patient Choice program is widely recognized as the national leader in tiered networks. It has proven expertise in ranking providers on cost and quality. Results have demonstrated that consumer demand for value drives providers to continually improve quality and manage total cost — leading to reduced cost trends and migration to enrollment of lower tiers.
About Patient Choice and MedicaThe Patient Choice program helps consumers better understand the wide variations that exist in the cost and quality of health care. Its pioneering approach enables consumers to gauge value and make informed choices about their health care — spurring health care professionals to compete on cost and quality and allowing employers to define and manage their health care costs. The program was acquired by Medica in March 2004.
Medica 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 health care 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.
About United Behavioral Health (UBH)Through its emphasis on evidence-based consumer-focused behavioral health benefit management services, UBH helps improve the health and well-being of people at home and at work. UBH’s comprehensive range of products and services are customized to meet the needs of the nation’s employers, health plans and public sector organizations. From cost-effective behavioral health benefit management services to complete work/wellness/life programs, UBH meets the diverse needs of its members while helping its customers to achieve long-term growth and success. Headquartered in San Francisco and available online at
www.unitedbehavioralhealth.com, UBH is part of the UnitedHealth Group (NYSE: UNH) family of companies.
About the National Business Coalition on HealthNBCH is a non-profit, membership organization of more than 70 employer-based health care coalitions, representing over 10,000 employers across the United States. A particular focus of the coalition is to accelerate the nation’s progress toward cost-effective, high quality health care and improve the value of health care spending. The NBCH eValue8 Awards recognize organizations that have implemented innovative, ground-breaking programs and provide a forum to communicate best practices.
# # #For more information, contact:Greg Bury, Medica
Office: 952-992-8437
Cell: 612-810-4556
E-mail:
greg.bury@medica.com