"If there's one thing that is probably equally important and maybe more important is cost and so the challenge has always been how do you get this done, how do you improve access and make sure that the cost of health care is kept at the same or lower level," he said. "And we've finally found a way to get that done, and that's the part that I'm just so happy and proud about."
Following this agreement, UH now participates in all major health insurance plans in Northeast Ohio, and Medical Mutual SuperMed network now has all major health systems in the region represented, according to the release. Medical Mutual members will be able to access all UH facilities with the highest level of benefits.
"The reason why this was so important is the beneficiaries of this agreement are really the thousands of patients who have come to us over the years and in many cases have paid higher deductibles to be able to access our health system," said UH CEO Thomas F. Zenty III.
Bedford and all of the main campus facilities were the entirety of the UH system at the time of the contractual decision in the 1990s. Other medical centers that have been added since then, such as Ahuja, Parma and Geauga, were worked into the network as they came online.
But Medical Mutual members who wanted to receive care on the main campus, which contains much of UH's specialty programs and technology, would have to pay out-of-network costs.
"It's just bothered me that we've had a major employer and a major provider that was sort of left out of our network," he said. "It wasn't the easiest thing in the world to get done, but because of all that, it just was important to us to get it done and we have. So we've improved access for all of our members, and we've done that without increasing cost. And both of those things had to happen or this wasn't going to work."
Chiricosta also was quick to note that Medical Mutual has maintained its strong partnership with the Cleveland Clinic.
Medical Mutual members already have access to UH doctors and other facilities across the UH system, but Chiricosta noted that some people still thought that all UH services were excluded from the MMO network.
Members now can access the full spectrum of services at UH, such as proton therapy, its cystic fibrosis program and the Angie Fowler Adolescent & Young Adult Cancer Institute.
Of Medical Mutual's 1.5 million members, about 650,000 of them live in Northeast Ohio.
The expanded access, Zenty believes, will bring more patients to UH, where primary care doctors and other physicians across the system treat a "very large number" of Medical Mutual patients. But when those patients needed a higher level of care, they'd have to either go through a challenging process for approval, pay higher deductibles or seek services elsewhere.
The setup also left Medical Mutual at a competitive disadvantage, Chiricosta said, because companies have said they don't want a product that excludes University Hospitals. Employers have decided to either not do business with MMO at all, or add a second option to provide access to UH.
"In both cases, that has hurt us over the years," he said. "We've done quite well despite having that competitive disadvantage. I'm excited to think about how we might do going forward with eliminating that competitive disadvantage."
"Medical Mutual brings all University Hospitals facilities into its SuperMed network" originally appeared in Crain's Cleveland Business.
