Solution partners

Insurers forge relationships with providers to improve care, lower costs

Posted on Sep 27, 2018 :: Health Insurance
Posted by , Insight on Business Staff Writer

Rising health costs continue to be a challenge, but as national efforts fail to come up with a solution, more insurers, businesses and providers are taking matters into their own hands by forming collaborative relationships that improve employee health with the goal of lowering costs.

“Problem-solving is all about getting the right people together, and we’ve worked hard at doing that,” says Curt Kubiak, founder and CEO of NOVO Health, an Appleton-based network of independent medical providers. “Collaboration has been part of our DNA for some time.”

For many people, cost is the main concern, so sharing information on how much a procedure will cost in advance can alleviate stress, he continues. NOVO works with providers to create bundled services, such as a knee replacement, and then works with insurance companies on a set cost. NOVO serves as an intermediary between its providers and insurance companies to develop pricing on delivered services.

Kubiak, who also serves as CEO of Orthopedic & Sports Institute, was first approached by WEA Trust with the idea of offering bundled services. OSI developed bundle pricing for 85 procedures, which meant a single price for a procedure.

That is a step away from the standard fee-for-service model and a move toward paying for quality, Kubiak says. “Offering bundled options benefits insurance companies and patients,” he says.

During the past year, NOVO has not only added additional providers in and out of the region but also has inked partnership deals with Network Health and The Alliance on bundled pricing.

“(Network CEO) Coreen Dicus-Johnson came out of the care delivery space and saw how we were working and knew we could provide Network with low-cost, quality care,” Kubiak says. “It’s good for them with their current members and good for attracting new members.”


Focus on wellness

Wisconsin’s largest health provider — Aurora Health Care — and Anthem Blue Cross Blue Shield — one of the state’s largest insurers — teamed up to create the Wisconsin Collaborative Insurance Co. and its Well Priority product. Well Priority uses data from the insurer’s claim records and Aurora’s medical records to better manage different clinical populations and their health issues, such as someone with diabetes. 

“Aurora has many more touchpoints with patients — or members, as they are referred to by insurers — than the insurance company does, which is really only at enrollment or if a problem comes up,” says John Foley, president of the Wisconsin Collaborative Insurance Co. “To us, having Aurora take over the clinical population piece, which is normally handled by insurers, made more sense. Aurora was also able to better see care gaps.”

Research shows patients tend to pay more attention when health advice comes from a medical provider than their insurer, Foley says.

“We’ve seen 75 percent to 85 percent engagement rates. That means after patients get a call about an issue — perhaps they are diabetic and may need to see their doctor more — they are more likely to schedule that appointment,” he says. “They see their provider and their health improves, which leads to lower costs.”

Businesses that choose WellPriority as their insurer — Aurora works with other health providers on the population health piece of the puzzle — also benefit from having an onsite nurse. The health provider can answer questions, treat simple injuries or illnesses and offer referrals to other medical providers.

“Businesses appreciate we’re working together,” Foley says.

Another regional offering — Robin with HealthPartners — brings Bellin Health of Green Bay and ThedaCare of Appleton together with Health Partners.

“Our focus is achieving the triple aim: enhancing the member’s experience, improving member health and making quality care affordable,” says Jim Enright, executive director of Health Solutions Sales, Northeast Wisconsin.

They work toward that triple aim, Enright says, by committing to putting customers first; collaborating with their provider partners and employer customers to bring about clinical quality and overall health improvement; and by looking at the total cost. “We look at resource use and price: the right care at the right place, at the right time, and at the right price.”


Another perspective

When Network’s Dicus-Johnson considers whether the Menasha-based insurance company should sign a contract with a health provider, several factors come into play, but one stands above the others: “We have a strong belief that providers and payors need to be on the same team,” she says.

For Network, that means the providers deliver high-quality care and are willing to share information and that their footprint mirrors the insurer’s, Dicus-Johnson says.

“We do everything we can to prevent fragmented care. We want to work with not only general providers in a certain area, but also specialists,” she says. “When your care is fragmented, it’s harder to navigate and you may not get the care you need.”

That means finding partners that offer both primary care and specialty care, Dicus-Johnson says.

“We strongly believe clinically integrated care makes it easier for patients/our members to get the care they need where they need it,” she says.


Another option on the table

Employers do not always have to partner with a health insurance provider to offer their workers quality health care at an affordable cost. Self-insured businesses, which means employers take on the risk of providing health insurance coverage to their employees, can join a cooperative such as The Alliance to provide workers with quality insurance at a good price.

Based in Madison, The Alliance started 28 years ago when a group of local, self-insured employers saw value in contracting with providers directly, but realized they didn’t have the necessary expertise or pool purchasing power, says Cheryl DeMars, president and CEO of The Alliance.

“A key part of our success is that our members are local employers, and we contract with local providers — there is a goal that everyone is working for the benefit of the community,” she says.

The Alliance, which has 245 employer members covering more than 86,000 lives, gathers information and shares data with its employer members. Member companies pay an annual fee, and at the end of the year any net revenue that remains goes back to them as a dividend.

“We’ve seen sevenfold differences in prices for something like an X-ray between providers. We pass that on,” DeMars says. “We also provide members with a united voice on the state and federal level related to important health issues.”

Employees at companies represented by The Alliance benefit from having a variety of health providers to choose from, says DeMars, adding its provider network includes 20,000 professional service providers at hospitals, medical clinics, chiropractic clinics, mental health clinics and home care agencies.

“Patients have more choice and they’re available to see the best quality providers at the best possible price,” she says.