Description of Health Advantage

HHC contracts with a primary care physician group, the Indiana University Medical Group (IUMG), and pays them a per member per month fee. The physician group is at risk for all primary care needs. Members choose a primary care physician and receive a personalized membership card, member handbook, 24-hour access to a nurse on-call hotline and other service components found in most commercial insurance plans.

The per member per month fee provides an incentive to the IUMG physicians to build relationships with their patients, encourage appropriate use of the delivery system and improve the provision of primary and preventative services. IUMG is also responsible for processing shadow claims data and providing other key data such as quality, utilization and patient satisfaction reports to HHC for tracking, quality control and future planning purposes.

Based upon its success with Wishard, and in an effort to assure geographical accessibility, HHC expanded the Advantage network to include other Marion County providers of indigent care such as HealthNet and Citizen's Health Center (federally qualified health care centers), Raphael Health Center, Shalom Health Center, St. Francis Neighborhood Clinic and St. Vincent Health Services.

In summary, the Health Advantage program puts a framework into place that supports health promotion and disease prevention, and better manages the care of the low-income and uninsured population of Marion County, which historically has significant health care needs. HHC encourages uninsured residents to seek out health care, recognizing that it is better to provide ongoing health care on the front end than on the back end, when a medical condition becomes complicated and difficult to treat or a crisis situation emerges.