Medica to pay Mayo Clinic based on patient health management

The agreement seeks to reward outcomes, affecting 10,000 Medica members
Email LinkedIn

Minnesota nonprofit insurer Medica has created a new arrangement with Mayo Clinic to provide individual members with in-network access to the renowned hospital, which will be paid based on how well it manages certain patients' health.

The one-of-a-kind agreement, which was announced Thursday, seeks to provide high-quality care at competitive prices by adjusting the current payment fee-for-service model to instead reward outcomes, MedCity News reported.

"This arrangement with Mayo Clinic provides the impetus for change through its focus on more effective and efficient delivery of care and a better understanding of the true costs of care," Medica CEO David Tilford said in a statement.

However, Tilford clarified that the insurer isn't seeking to dictate how Mayo Clinic delivers care. "It is the provider, in this case Mayo Clinic, who is redesigning the system to produce the best possible outcomes at the most efficient price," he said.

Dannette Coleman, Medica's vice president and general manager for individual and family business, echoed Tilford's claims, saying that the new deal "really will drive forward access to high-quality healthcare at really competitive prices."

Both Medica and Mayo Clinic officials chose not to disclose specifics regarding how exactly Mayo would be paid and what outcomes Mayo must achieve, claiming those details are proprietary. But Coleman did say that the financial arrangement "will evolve as the population changes with healthcare reform," reported the Rochester Post-Bulletin

The new agreement will affect up to 10,000 Medica members. The in-network coverage of Mayo Clinic is available July 1 for new members, while existing Medica members can apply for coverage when their plan is renewed, reported the Pioneer Press.

To learn more:
- read the MedCity News article
- see the Rochester Post-Bulletin article
- check out the Pioneer Press article

Related Articles:
Medica teams up with provider in HMO-style health plan
Minnesota health plan releases doctor ratings despite opposition
Health coaching program saves $22 per member monthly
BCBS of Massachusetts charges higher fees for expensive hospitals
Horizon urges members to avoid hospital due to high fees