Ohio Kentucky & Indiana | Fall | 2009 | Health Plan Analysis

Three major insurers — Anthem Blue Cross and Blue Shield, Humana and UnitedHealthcare — have teamed up with 11 local physician group practices and a local organization to pilot a patient-centered medical home scheme in the Cincinnati market. Organizers hope to realign care delivery and reimbursement in ways that will improve patient outcomes, particularly for those with chronic conditions. Humana got an early start and is already reimbursing some practices with a per-member, per-month case management fee. All will officially launch Oct. 1. Getting doctors to participate required the collaboration of the three leading insurers in the market.
Indiana's Medicaid Care Select program to serve certain non-institutionalized aged, blind and disabled beneficiaries has come to full implementation, and has already seen some success. As evidenced by the disbursement of holdback funds, the two participating health plans — ADVANTAGE Health Solutions and MDwise — managed to cut medical cost trend to just 1 percent, while achieving quality gains and high member satisfaction.
In Ohio, four of the largest public employee retirement organizations have formed a consortium to consolidate their prescription drug purchasing, and have now opened up the consortium to every other public employee group in the state, from local municipal governments and school districts to higher education staffs. The Rx Ohio Collaborative already has nearly 500,000 covered lives under a single contract with Express Scripts even as all the local groups maintain the autonomy to keep or create their own benefit designs. In the long run, as many as 1 million public employees could end up in a single drug buy.