Redesigning Health Care to Improve Patient Health

Jim Parker, President

Indiana University Health (IU Health) has long recognized the value of provider-led insurance plans.  Since the early 90s, we have operated our own health plan, in addition to co-owning a managed care plan for Medicaid patients.  As part of the integrated IU Health care delivery system, IU Health Plans uses physician-led teams to develop flexible, individualized care plans for our customers.  The success of this model is most evident in IU Health Plans’ Medicare Advantage (MA) program.

An infographic that connects care teams, specialists and members together to show how care can be integrated effectively.

In the IU Health MA program, the physician-led care team has access to real-time patient data, including claims data, through the system’s electronic medical record (EMR) platform.  Predictive modelling allows the care team to assess and assign risk to plan enrollees.  The care team then aligns services (both clinical and non-clinical) based on the risk intensity of each patient.  For high risk patients, care is managed intensely using enhanced patient-physician communication, nurse care managers, and frequent follow-up contact between visits.  Since implementing this program, IU Health Plans has seen a 6% reduction in emergency room visits, 22% reduction in hospital admissions, and 33% reduction in MRI/CT use on a per-member per-month basis. In addition, our Health Plans has seen greater than 80% patient engagement rates.  This translates into better health outcomes for the patient and lower health care costs.

This shows that ER visits are down 6%, hospital admissions are down 22% and MRI/CT PMPM are down 33%.

Most importantly, however, our patients recognize the value of this program, ranking IU Health Plans’ Medicare Advantage program 4.5 out of 5 stars from the Centers for Medicare & Medicare Services (CMS), one of the highest rated Medicare Advantage plans in the state of Indiana.   

IU Health believes that to improve health outcomes and slow cost growth, it is essential to align the interests of payers and providers.  We must move from a system that pays providers on the basis of the volume of care they provide – as in the traditional Medicare program – toward a new model that rewards providers for achieving real and sustained improvements in patient health outcomes while managing costs more effectively.  Programs like MA support this model by aligning the interests of payers and providers around the clinical and financial outcomes of the population of beneficiaries they serve.

IU Health Plans is transforming the way a health plan works with physicians to improve quality of care while reducing health care costs.  Building upon the trusted relationship between the patient and physician, we are redesigning health care to be more responsive and nimble in providing preventive services and coordinated care, improving chronic disease management, closing gaps in patient care, and reducing costs.  Undoubtedly, Medicare Advantage delivers enhanced value for Hoosier seniors.