Introduction

Employees at the University of Minnesota receive health insurance benefits through the State Employee Group Insurance Plan (SEGIP). University employees comprise approximately 15,000 of the 60,000 employees in SEGIP. Health insurance benefits are determined during contract negotiations between the Minnesota Department of Employee Relations (DOER) and the various bargaining units.

Each year, DOER works with HealthPartners, Medica, and the State Health Plans to provide the 60,000 employees in SEGIP with health plans offering the greatest quality and access to physicians at a reasonable cost. The need to balance cost, quality, and access created the need for closer relationships between DOER and the health plans, and the health plans and their physicians. In today's managed care environment, health plans work with physicians to make informed decisions about the best and most cost-effective course of patient care.

Physicians decide when, where, and how to treat patients who come to them for care. Health plans help to manage patient care in several ways, including the use of reimbursement policies or payment methods. A health plan's reimbursement policy is one of the most important ways that a plan can influence physicians' treatment and referral patterns. It must be noted that these payment methods are only one of several management tools that health plans use to help physicians manage their patients' care. Health plans use different reimbursement policies to provide physicians an incentive to control health care costs, to increase patient use of primary and preventive care, and to practice the highest quality health care possible.

Why should you care about how your health plan pays your physician? How a physician is reimbursed may affect a physician's treatment style and referrals to specialists and hospitals. Your physician is acting in your best interest, but is accountable to the health plan in a way they had not been prior to managed care. Managed care applies business practices to health care with the aim of providing high quality, cost-effective care. This guide will help you understand this relationship between health plans and physicians by explaining different payment methods and their potential effects on your care. Several phone numbers and contacts are listed at the end of this booklet if you feel the need to exercise your rights as a patient. You should also talk with your physician about any questions you have and work together with your physician to address any other issues or questions.