Insurer, Mayo Clinic Use New Model To Sell New Plan

By Dan Linehan, The Free Press, Mankato, Minn.
McClatchy-Tribune Information Services

June 14--MANKATO -- Mayo Clinic Health System and the insurer Medica are saying their collaboration is news for two reasons: First, Medica will directly sell consumers an affordable health plan that includes Mayo Clinic coverage.

That, they say, is new because it includes the best coverage, Mayo's, and will be sold to individual customers. Those in employer-offered plans can already get it. It will be sold to residents of 22 southeastern Minnesota counties, including Blue Earth County and the seven counties it borders (though not Sibley County).

Between 5,000 and 10,000 of Medica's current customers in the 22 counties will be affected, starting July 1.

But it's the way that the insurer and the provider are structuring the deal that they say may help change medicine.

Typically, insurers get paid for procedures. This leads doctors to order many expensive tests, which may or may not make patients healthier.

Minneapolis-based Medica said the new deal will pay for healthier people, not just procedures, an often-stated goal in medicine.

"It sets a new standard because we are both deeply committed to paying for value," said Dr. John Noseworthy, president and CEO of Mayo Clinic.

The deal's promise is that patients won't have to make a trade-off between cost and service: They get Mayo Clinic specialists at a price comparative with plans that rely on what has typically been less expensive care.

But the companies were vague about how they plan to meet that goal. The parties didn't release any financial figures, nor were they specific about how patients will see care that's different from other providers. How, in other words, will a different billing method (outcomes instead of procedures) look different to patients? For example, would patients still have to pay co-pays for procedures or would they only pay for measurable improvements in their health?

Dr. Noseworthy said Mayo's "patient-centered, team-based care," will "by its very nature" drive down waste and keep costs down.

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