INSIGHT ON: Health Insurance – Healthy options

Posted on Oct 1, 2014 :: Health Insurance , Insight On
Sean P. Johnson
Posted by , Insight on Business Staff Writer

HealthIns

Greg Devine has high hopes for his newest health care calling.

“We want to lower the cost for health care,” says Devine, a senior vice president at ThedaCare who was recently tapped to serve as president of a new statewide health care collaboration. “I do mean lower costs, not just slow the curve.”

He will have his work cut out for him.

National survey data shows that health care costs have escalated by more than 60 percent since 2000, and increases of more than 3 percent per year are common. Nationally, health care spending per capita has risen from $4,127 to $6,815. The numbers in Wisconsin have climbed from $4,206 to $7,233.

By sharing resources, expertise and best practices, the new network may finally be able to break that cycle, Devine says, providing higher quality care at certain and transparent prices.

“We are very much aware of the financial burden many people face now with health care,” Devine says. “We want to deliver the highest quality health care we can and be transparent with that information.”

Announced in August, the new partnership — not yet named — consists of ThedaCare; Bellin Health, Green Bay; Aurora Health Care, Milwaukee; Aspirus, Wausau; UW Health, Madison; and Gundersen Health System, La Crosse. The affiliation creates a network of 44 hospitals and 5,680 physicians with a combined service area accessible to nearly 90 percent of the state’s population.

While it’s not a merger — as each of the six providers will remain independent — members of the group will work collaboratively in ways that will help the overall goal of improving care. That could mean sharing information, talent or resources, though many of the finer details have yet to be worked out among the six organizations.

“We will learn as we go,” Devine says. “There is already some level of collaboration today among these six providers. The idea now is to do it across a broader geography with evolving markets and evolving demands.”

Those evolving demands include a shifting focus on improving health and preventative care — not just treating the sick — and the still evolving impact of the Affordable Care Act, which is expected to lead to more individual health insurance policies rather than employer-sponsored plans.

In many ways, health care is facing the challenge to do more with less that has led to evolution and innovation in other industries, says Dustin McClone, executive vice president-employee benefits at McClone Insurance Group, a Menasha-based insurance and risk-management firm.

“They are being pushed to produce more value and reduce costs,” McClone says. “I think the collaborative approach will help them with the efficiencies that drive that.”

It’s too early to tell what that will mean in terms of insurance products, but if the new network can produce the efficiencies, it would make sense that costs would be at least contained, McClone says.

“In the long run, if the network can create more value, and the focus shifts to keeping us healthier instead of reacting to illness, we should see more cost effectiveness,” he says.

Creating a system that would stem the increasing costs of health care and health insurance would be a major breakthrough in Wisconsin, a state that is hampered by higher costs, says Pamela Branshaw, partner in charge, employee benefit services for WIPFLi CPAs and Consultants. If the new network can foster a climate where competitive forces can drive costs down, then consumers and business should benefit.

“I think the premise is a good thing,” Branshaw says. “Part of the issue of health care is a lack of consistency and transparency with pricing. You can call three providers to ask the cost of the same procedure and get three different prices with no real explanation.”

Branshaw has high hopes the collaborative approach will produce the results of better and more cost effective care. She sees some initial opportunities with a single electronic medical records system — all the systems use the same provider — that could create more efficient health care delivery.

Other possibilities include purchasing or identifying populations at risk of a particular illness and disease and taking steps for prevention and early treatment.

Branshaw would also like to see the new network open itself to additional insurance providers as it moves forward, injecting some additional competitive forces into the mix. The network is currently served by Blue Cross Blue Shield, but the providers say they are open to adding other carriers.

How all those issues play out is the challenge that Devine is looking forward to meeting. Given the infancy of the network, he says it’s difficult to provide specifics of any initiatives that might be pursued. For example, electronic records could be an area of opportunity, but a full merger of the multiple systems could also prove to be impractical once the details and costs are known.

But those types of challenges represent the opportunity the network provides, he says.

“What can we do to anticipate the needs of the patients today and the future and build for it so we can be ready?” Devine says. “We want to deliver a better health experience.”

ON THE WEB

A new statewide network of providers will give patients access to 44 hospitals and nearly 6,000 medical providers across the state. The providers involved include:
» ThedaCare, www.thedacare.org
» Bellin Health, www.bellin.org
» Aspirus, www.aspirus.org
» Aurora Health Care, www.aurorahealthcare.org
» Gundersen Health System, www.gundersenhealth.org
» UW Health, www.uwhealth.org