Medical Mutual of Ohio, Health4 launch program to reward quality care

Health4, the clinical integration program of the Health Group of Ohio, and Medical Mutual of Ohio have launched a coordinated payer-provider program that aims to reward hospitals and doctors for keeping patients healthy and reducing hospitalizations.

Under the new agreement two organizations will actively share claims and medical data aimed at better coordination of care for patients and provides a payment system that will reward Health4 doctors for attaining specific healthcare quality measures and producing overall cost savings.

[See also: Large multi-specialty medical groups offer higher quality, lower cost care; Medicare to debut quality bonus payment demonstration for Medicare Advantage]

"We should pay for what people want: high-quality, cost-effective healthcare that heads-off catastrophic financial and medical situations," said Kevin Lauterjung, Medical Mutual's executive vice president of managed care.

Lauterjung said the program provides an incentive to focus on patients with complex medical conditions, since effectively managing and improving their health represents the largest potential savings. The integration of insurance claim data and clinical data is intended to provide doctors in the program with the most accurate snapshot of a patient's current medical condition.

"What makes this program different from others in the industry is that there is an incentive for Medical Mutual, the payer, to help the physician organization be successful," said Lauterjung, "If Health4 is successful, then everybody wins. The patient wins with better health. The doctors and hospitals are rewarded for keeping people healthy, and above all, we all win with quality healthcare resulting in lower costs."

Health4, founded in 2009, is a clinically integrated healthcare delivery model consisting of The Medical Group of Ohio (MGO) physicians and OhioHealth's facilities and services. It currently has an integrated network comprising more than 1,600 physicians and OhioHealth facilities. The physicians – comprising both primary care doctors and specialists – work with the hospitals to actively coordinate patient care and work in a program focused on continuous quality improvement.

"The Health4 program has demonstrated significant increases in the number of patients receiving wellness visits," said Ben Humphrey, MD, CEO of MGO. "And this fact is believed to be directly related to the demonstrated decrease in the number of emergency room visits, hospitalizations and total medical costs of those receiving preventive visits."