Improving Quality and Outcomes

As costs continue to rise for medical services, health insurance companies have ramped up their efforts to find innovative ways to analyze the quality of care being provided by medical professionals and forging new paths to new payment structures.

Best of the Best

  • 15 of Ohio’s health plans were listed in US News and World Report’s Best Health Plans rankings for Commercial, Medicare and Medicaid plans
  • 85% of the OAHP’s health plans offer products accredited by either the National Committee for Quality Assurance or URAC
  • The number of health plans volunteering to be measured jumped by 9% in 2009

Outcomes

  • 4 % improvement in access to preventive and ambulatory health services for Ohio’s Medicaid Care Coordination’s Aged, Blind, and Disabled population
  • 88% of health plans analyze pharmacy data to determine if patients could benefit from disease management programs
  • Up to 205,000 lives saved in the last decade through consistent delivery of evidence-based health care

Focus on Appropriate Care in the Appropriate Setting

  • Participants in Medicare Advantage spent fewer days in the hospital, and reduced emergency room visits by 24%
  • Through Ohio Medicaid Care Coordination, infant emergency room visits decreased by 28%
  • Ohio’s health plans help in saving up to $3.5 billion nationally in avoidable medical costs each year

Telemedicine

  • Health plans are teaming up with technology companies to help build nationwide telemedicine networks connecting underserved areas with medical care
  • Investing in the use of new technologies to connect providers and consumers
  • Providing a new source  of access for consumers

Technology

  • Ohio is one of two states in the nation that are part of a web portal project to link insurers and physician offices in real time
  • Insurers are connecting with consumers 24/7 with apps that can be used on smart phones
  • Insurers are using text messages to remind consumers about upcoming appointments with providers

Medical Home

  • Leading efforts for pilot programs in support of primary care providers and testing new payment systems
  • More than 80% of health plans include pay-for-performance incentives in provider contracts, tying results to reimbursement
  • As part of integrated care through a medical home, health plans promote prevention and help patients keep up with recommended services