If you’re one of Humana’s 41,000 Medicare Advantage members in Franklin, Fairfield, Licking and Delaware counties, you can expect your family doctor to know far more about which specialists you're seeing and how often you see them.
Humana officials expect that increased awareness to translate into better coordination of care, meant to improve members’ health at a lower cost.
The health insurer reached the new “pay-for-value” agreement with Health4, a health-care delivery model co-owned by the OhioHealth hospital system and the Medical Group of Ohio. The three-year deal, which took effect on Jan. 1, was disclosed this week.
Medicare Advantage patients “are going to see the same outcomes that we’ve demonstrated ... in the commercial population,” said Dr. John Schmeling, the Medical Group of Ohio’s CEO.
Since its creation in 2010, MGO officials said the organization has improved rates for breast, cervical and colorectal cancer screening, as well as for preventive visits and diabetes management.
As part of the deal with Humana, emphasis also will be placed on prescribing generic medications and avoiding X-rays on a patient’s initial visit for back pain, Schmeling said.
Humana has established similar partnerships in Cincinnati and northeastern Ohio, said Larry Costello, the insurer’s president for senior markets in Ohio.
Doctors have incentives to meet certain quality measures. A spokesman declined to specify how large the incentives would be, saying only that the payments would be a “needle-mover in terms of enabling proactive, integrated care delivery.”
Officials also declined to say how much improvement must be seen for specific health conditions in order for physicians to be rewarded monetarily.
Costello said the partnership is one of the first and largest such partnerships involving Medicare patients in central Ohio.
Such “accountable-care” deals are becoming common across the state. In October, for example, UnitedHealthcare and Mount Carmel Health Partners embarked on a similar three-year deal meant to improve the health of 20,000 patients.
