Health plans operating in the Toledo area largely have deserted a holdover of 1980s managed-care contracts by eliminating "steerage," which sent patients to a single, large hospital system. A new state-funded program, called Healthy Indiana Plan, has begun providing health insurance for poor residents of that state, and it features a consumer-driven account providing up to $500 a year in free preventive care. In Kentucky and Ohio, Anthem Blue Cross and Blue Shield is introducing a new Medicare product called SmartSaver that functions like a consumer-driven plan, except it is targeted to seniors. And Kaiser Permanente's Ohio region has become the last of the Kaiser Permanente markets to bring the nonprofit insurer's personal health record system online. The system allows members to send secure e-mails to physicians, set appointments and view laboratory tests online.

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