A new health insurance plan, designed to attack the high health care costs in the Milwaukee area, will be offered starting Jan. 1, and many area employers will spend some of the next six months deciding if they want to try it.
The plan was created by the Business Health Care Group of Southeast Wisconsin (www.bhcgsw.org) and Humana Inc.
Humana says it expects the plan, in its first year, to result in double-digit percentage health care cost savings when compared with traditional preferred provider organization (PPO) health plans.
"Our goal is to deliver a market-driven health care delivery system in Milwaukee," said Dianne Kiehl, executive director of the Business Health Care Group of Southeast Wisconsin. "Our goal is to get our (health care) costs within the Midwest average. That has to be attacked on several fronts."
The group has 25 voting members, businesses and groups of businesses, with about 135,000 insured clients. The member companies have agreed to use the combined purchasing power of their employees and family members to receive health care coverage at a lower cost.
Many of the member companies of the Business Health Care Group are the largest businesses in the Milwaukee area, including Manpower Inc. and Rockwell Automation Inc. As a result, some employers mistakenly believe the plan is only for large corporations. That is not the case. Employers with as little as two employees can be part of the Business Health Care Group.
The group is trying to convince as many firms as possible to join so they can maximize their purchasing power to help negotiate lower prices for health care services.
Expanding the membership of the Business Health Care Group is critical to its success, Kiehl said.
"We are very actively engaged in making sure the business community understands that," she said. "We from day one understand the strength and the value of small businesses. We are dependent on their engagement in order for us to be successful."
It costs $1,000 for each company to join the Business Health Care Group, unless they join through a sponsoring organization, such as the Metropolitan Milwaukee Assocation of Commerce, in which case the sponsoring organization pays the fee.
"Small companies can benefit from collaborating with the larger businesses, as they are a large part of the economic system," said William F. Koranda, controller for Mequon-based Jorgensen Conveyors Inc. The company has about 70 employees and is part of the Ozaukee Employers Coalition on Health, a sponsoring organization for the Business Health Care Group. "The more companies that participate in this coalition and its efforts, the greater our potential will be in moving the market, empowering consumers and improving control of our health care costs."
The plan’s network, unveiled recently, includes physicians and hospitals from Aurora Health Care, Columbia St. Mary’s Hospital and Physician Group, Children’s Hospital and Medical Group, ProHealth Care, Froedtert Hospital and Community Health, the Medical College of Wisconsin and others.
Those health care providers will benefit from the opportunity to serve the lives covered by members of the Business Health Care Group.
Major southeastern Wisconsin health care providers that are not included in the plan’s network include Covenant Healthcare, West Bend-based Synergy Health, Racine-based All Saints Healthcare and United Hospital System in Kenosha County.
"The partners who are in the network were more responsive to the overall objectives of the Business Health Care Group than those who are not in the network," said Larry Rambo, chief executive officer of Humana’s Wisconsin and Michigan markets. "We had to make it clear that not everyone would be included in the network. We told providers to, ‘give us your best proposal.’ We got a few better responses from that than if we said, ‘You’re going to be in our network. no matter what your response is.’"
The network will work like a traditional PPO. Employees and family members of companies in the Business Health Care Group will have to pay higher costs if they visit providers who are not in the network.
The health care providers in the network will benefit because the plan will steer most of the Business Health Care Group’s employees and their family members to the doctors and hospitals of those providers.
The health care providers that were not included in the network will likely miss out on most of those patients.
In addition to being included in Business Health Care Group network, Aurora Health Care also recently announced it has reached an agreement to be included in UnitedHealthcare’s network. UnitedHealthcare is the state’s largest health insurer.
In 1996, Aurora and PrimeCare Health Plan Inc., now UnitedHealthcare, ended their relationship because of a dispute over pricing and other issues.
The new 15-year contract marks the conclusion of that dispute.
In creating the network for the Business Health Care Group, Humana says it used advanced methodology to analyze the efficiency of physicians for area health care providers. The analysis was an attempt to determine how effective physicians are at treating each illness. Instead of just looking at which health care provider charged the lowest amount for each procedure, Rambo said, Humana tried to determine which health care providers cured illnesses in the shortest period of time.
Shorter illnesses mean patients get better faster, with less visits to the doctor, which also results in a cost savings.
"Humana has developed a methodology to evaluate episodes of care," Rambo said. "Unit cost alone doesn’t get you where you need to be."
Humana also asked providers if they were willing to provide price and performance information to consumers, and if they were willing to join the Wisconsin Collaborative for Healthcare Quality (www.wchq.org).
The collaborative is an attempt to create a statewide database to compare the quality and cost of medical procedures by health care providers. Health care providers are not required to participate in the collaborative to be part of the Business Health Care Group network, but the group is strongly encouraging them to participate.
Aurora Health Care, which previously was not participating in the collaborative, now says it plans to join.
"What we are doing is using the purchase power of the Business Health Care Group to convince more physicians that participating in these quality standards is a worthwhile exercise," Rambo said.
"Our participation is going to focus on the physician group measures," said Aurora spokesman Ron Irwin. "This is one area that has not been included in the state and national quality initiatives that we have been participating in."
More hospital construction
Several major hospital construction projects in the Milwaukee area are under way or will begin later this year.
Columbia St. Mary’s recently announced it is planning a $417 million project to consolidate the Columbia and St. Mary’s hospitals into one campus at Lake Drive and North Avenue on Milwaukee’s east side. The project will include a 670,000-square-foot core hospital, a new 25,000-square-foot cancer center and two medical office buildings totaling 215,000 square feet. About 190,000 square feet in the cloverleaf building on Lake Drive will be renovated, as will the historic east facility, built in 1909. The project will break ground this fall and be completed in 2010.
Froedtert Hospital is building a $120 million, 248,000-square-foot expansion. The project will add space for cancer clinical programs, research and faculty offices. It is expected to be completed in 2007.
The Medical College of Wisconsin and Children’s Hospital are building a $117 million, 300,000-square-foot biomedical research facility. The project is expected to be completed in 2007.
However, one project that hit a roadblock earlier this year is Aurora Health Care’s proposed $85 million, 88-bed hospital that would be built in the Town of Summit near Oconomowoc. Waukesha-based ProHealth Care, which owns Waukesha Memorial Hospital and Oconomowoc Memorial Hospital, lobbied against the proposed Aurora hospital saying it was unneeded and would result in higher health care costs in the area. The Waukesha County Board agreed and rejected the development. In response, Aurora and the Town of Summit have filed a lawsuit against Waukesha County.
Business Health Care Group of Southeast Wisconsin members
Badger Meter
Brady Corporation
Briggs & Stratton
Bucyrus International Inc.
DaimlerChrysler Corporation
Direct Supply Inc.
Everett Smith Group Ltd.
Harley-Davidson
Husco International
Johnson Controls Inc.
Journal Communications
Joy Global Inc.
*Kenosha Area Business Alliance
Ladish Co. Inc.
Manpower Inc.
Marshall & Ilsley Corp.
*Metropolitan Milwaukee Association of Commerce
Midwest Airlines
Miller Brewing Co.
*Ozaukee Employers Coalition on Health
Robert W. Baird & Co. Inc.
Rockwell Automation
Serigraph Inc.
*Waukesha County Chamber of Commerce
* denotes sponsoring organization
July 8, 2005, Small Business Times, Milwaukee, WI
