Many managed health care plans are seeking to achieve an appropriate balance among quality outcome for their members, cost effectiveness for their employers, and acceptable levels of reimbursement for their physicians. From our experience, it appears that most managed health care plans are currently paying their ob/gyn physicians between 80% and 120% of Medicare reimbursement rates. In virtually every market with which we are familiar, some ob/gyn physicians have voiced complaints about the current reimbursement rates.

For managers of health plans, traditional fee-for-service reimbursement creates somewhat of a quandary. How does a health plan reward physicians who are doing a good job taking care of their patients in a cost-effective manner without also rewarding those few physicians who may be over-utilizing?.

OGM's Operating Models each offer important advantages over a traditional fee-for-service network.

• Developed specifically for Ob/Gyn practices
• Holds physicians individually accountable.
• Allows health plans to achieve significant savings.

• Over 10 years worth of experience with Ob/Gyn pay-for-performance programs.
• Metrics developed by Ob/Gyns for Ob/Gyns.
• Fee increases are directed into the pay-for-performance program.

• Does not require information system changes.
• Can be applied to HMO, PPO, and ASO products.
• Plans can save $1 PMPM.

• Supports open access.
• Gatekeeper restrictions are not necessary.
• Rewards physicians for attracting and retaining patients - not for doing more procedural work.
• Increases HEDIS compliance.
• Reduces unnecessary surgery.