The organizations say businesses could save big with the insurance offering.
Medica and Fairview Health Services are adding a new twist to their ongoing effort to work together to lower health costs.
The two organizations said Tuesday that they are offering a new insurance plan in which patients will need to stay within the Fairview system, which has nearly 350 clinics and seven hospitals, including Amplatz Children's Hospital and the University of Minnesota Medical Center, Fairview.
If that sounds like the discredited HMO model of the 1980s, think again, said Medica's Dannette Coleman, vice president and general manager of individual and family business at the Minnetonka-based insurer.
"In this arrangement you are choosing within a large care system," she said. "You have much more freedom than you did in the days of HMOs and gatekeeper products."
Back then "it was about the plans and providers trying to shift costs to one another," she added. "We have so much more data and information and ability to share information with one another. The focus is more now on quality and health outcomes."
The partnership expands on a relationship dating back to 2009, when Medica and Fairview entered a three-year contract to try to change the way health care gets paid for. Instead of the traditional method of getting reimbursed on the number of treatments, Fairview earned financial rewards from the insurer when it found less costly ways to provide good patient care.
That basic idea has been expanded upon as a tenet in the federal reform efforts, which calls for health care providers to become Accountable Care Organizations, or ACOs, that are responsible for providing comprehensive care.
The Fairview-only health plan is available as stand-alone and as part of a suite of options Medica offers through its My Plan platform.
My Plan is essentially a private insurance exchange where people use an online questionnaire to help them choose among 20 Medica plans with various deductibles and benefits. The Fairview network will mirror those 20 plans.
Employees at businesses that offer the defined contribution plan, known as Fairview Health Advantage with Medica, can save as much as 50 percent compared with other Medica options, according to the insurer. Individuals who enroll in the Harmony with Medica and Fairview plan can save up to 10 percent.
The plan will be available April 1 for businesses that offer health benefits and for individuals and families who buy health insurance on their own.
Those enrolled in the Fairview network plan can dial a single phone number to get help with a question about their claims and benefits as well as to talk to a nurse. "Virtual visits" will be available for patients to talk to doctors via video conferencing through their computers.
The My Plan platform is a way for Medica to try to expand market share in the individual and small business market ahead of 2014, when state-run exchanges will go online as part of the federal health law.
"Medica believes that as we go forward in this new world of exchanges, the providers have unique things to offer," Coleman said. "The status quo we have today doesn't create an environment where providers are competing. That's what we're trying to do with these ACO products is work closely with providers and allow them to compete on price, quality and customer service."
Jackie Crosby • 612-673-7335