Provider-owned health plans: make quality health care a choice, not an accident.

• Position: Indiana SMALL BUSINESS REFERENCE GUIDE

There is a different model for health care funding and delivery that produces predictable and affordable access to quality providers. Indiana has five provider-owned health plans that offer broad and comprehensive arrays of benefit packages on a regional basis. Collectively, these provider-owned plans serve virtually every county of the state.

Through a variety of contracting strategies, these health plans contract with the highest quality and most dedicated providers to help their members manage their health care needs. These providers are typically aligned with contracting entities that integrate physicians, hospitals and ancillary providers into seamless networks.

What are the values-based propositions of provider networks, often called physician hospital organizations (PHOs) or integrated delivery systems?

First is the emphasis on collaboration of evidence-based medicine and the measurement and reporting of outcomes. All provider-owned plans and many of the participating provider networks actively participate in the Health Plan Employer Data and information Set (HEDIS[R]) reporting initiative. HEDIS is a set of standardized performance measures designed to ensure that consumers have reliable information on the performance of managed health care plans. The performance measures are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. It also includes consumer ratings on customer service, access to care and claims processing. HEDIS is sponsored supported and maintained by NCQA.

Secondly, in collaboration...