Two competing Omaha health care organizations are putting nearly 17,000 people — employees and their spouses and children — into a single medical population that can use both organizations' doctors, hospitals and clinics at in-network prices.
The new network of the Nebraska Medical Center and Methodist Health System will test methods for managing and paying for medical services that move away from traditional “fee-for-service” practices.
Instead, the combined care providers will assume responsibility for the group's overall health care, from encouraging healthy living to following up after surgery, in an effort to be more efficient, control costs and improve medical outcomes.
If the new plan works, large and medium-sized employers in Omaha would be offered the same deal next year and Medicare patients would be able to join in 2016.
“Everybody is on this journey” to improve health care while controlling costs, said Dr. James Canedy, chairman of the Accountable Care Alliance, a corporation formed by the Med Center and Methodist. “But no one has this perfect map that we can follow.”
The Alliance manages the plan, called the Joint Employee Health Plan Network. Officials from Methodist and the Med Center said Tuesday that the plan is in line with objectives of the federal government's health care reform, including the Affordable Care Act.
The Med Center group includes UNMC Physicians, Private Practice Associates, the Nebraska Orthopaedic Hospital and the Bellevue Medical Center. The Methodist system includes Methodist Hospital, Methodist Jennie Edmundson Hospital, Methodist Women's Hospital and their affiliated doctors.
Previously, a Methodist employee using a Med Center hospital would pay out-of-network rates, and vice versa. Now, although their health plans remain separate, the charges are unified at lower, in-network copayments, deductibles and other out-of-pocket costs.
Such systems are in various stages of testing and operation in other cities. They offer “shared risk” for employers, consumers and care providers, with each having a financial stake in keeping people healthy and providing the right care at the right time.
The transition away from fee-for-service payments must be gradual, said Dr. William Shiffermiller, medical director for the Alliance, because those fees still provide the bulk of the revenue for medical providers.
This year's “population health” data on patients, treatments, costs and outcomes with the combined network will help determine how it will be offered to employers next year, Schiffermiller said.
Eventually, he said, doctors and other providers will assume more financial risk of keeping people healthy and treating them efficiently and, in the end, helping to lower health insurance rates.
Mark Burmester, vice president of strategic planning for Methodist, said the system of paying fees for each medical service is “very unsustainable” in the long run.
Although the Alliance's network is “narrow” in the sense that it charges higher prices for out-of-network doctors and facilities, he said, it is comprehensive in that it has every medical specialty and offers facilities throughout the Omaha area.
Instead of providing care for each health “episode” such as an infection or heart attack, primary care doctors' offices will become “patient-centered medical homes,” with health coaches or navigators working to keep patients healthy.
Part of the new network's advantage for employees is geographic, said Deb Dinsmoor, director of human resources operations for the Med Center.
In addition, plan members have financial incentives to stay healthy, said Holly Huerter, Methodist's vice president for human resources.
Correction: Accountable Care Alliance's name was incorrect in a previous version of this story.