Providers and insurers join forces to better serve patients
There’s no question the Affordable Care Act transformed the landscape for health care providers and insurers.
One of the biggest change is the partnerships formed by once-competing health care systems as they seek to pool resources to drive down costs and improve patient care. Wisconsin is home to two major health system collaborative organizations – AboutHealth and the Integrated Health Network of Wisconsin. Those programs are moving away from a fee-for-service payment model to one based on value, where care providers are eligible for payment incentives based on meeting evidence-based measures such as lower hospital readmission rates and chronic disease management, patient satisfaction, disease prevention and total cost savings.
To make that possible, the organizations partner with insurance providers. Last year, Arise Health Plan, a Madison-based wholly-owned subsidiary of WPS Health Insurance, signed a singular contract to sell co-branded products with seven of the eight AboutHealth providers (one member – Marshfield Clinic – joined as contract negotiations were finalized and isn’t part of the agreement.)
“Getting that contract signed was a huge deal,” said Scott Kowalski, executive vice president of WPS Health Insurance and chief operating officer of Arise Health Plan. “It required a lot of work on everyone’s part and shows you just how far collaboration in health care has come.”
Formed in 2014, AboutHealth members include Aspirus, Aurora Health Care, Bellin Health, Gundersen Health System, Marshfield Clinic Health System, ProHealth Care, ThedaCare and UW Health. Geographically, the network covers nearly all of Wisconsin.
“We have the triple aim of improving the quality of patient care, lowering costs and making the experience more enjoyable,” said AboutHealth President and CEO Greg Devine. “We want to be involved in driving payment reform and award providers for quality, and by joining together we can better do that.”
The Integrated Health Network of Wisconsin, launched in 2010, consists of Agnesian HealthCare, Columbia St. Mary’s, Froedtert Health, Hospital Sisters Health System, the Medical College of Wisconsin, Ministry Health Care, Prevea Health, SSM Health and Wheaton Franciscan Healthcare. IHN coverage is focused in eastern Wisconsin and central parts of the state.
“The ACA really got the ball moving on the formation of Accountable Care Organizations (ACOs), which is how IHN got its start,” said IHN CEO Kurt Janavitz. “Health systems realized people were seeking care across multiple systems and there was no true picture of what was going on with a patient’s health. There was just this realization that we needed to collaborate without giving up full control.”
IHN’s care model is consistent across its participating health systems, whether it’s the transitional care model, where a care navigator reaches out to a patient after a hospital visit to answer questions and make sure he follows up with his primary care provider, or complex care management for patients with chronic diseases such as asthma and diabetes, to make sure they get the right preventative care.
“As all of it comes together, it improves the quality of care delivered to patients while lowering costs,” Janavitz said. “We’re on the leading edge of what’s going on in the health care industry as it changes from getting paid for every procedure or appointment to how an overall patient population is cared for.”
As the health care systems aligned, it made sense to look for insurance companies to partner with, Janavitz said. Some were natural, such as IHN working closely with Network Health, which is owned by two members, Ministry Health and Froedtert Health. They also formed an ACO with UnitedHealthcare.
The insurer, which has 1.5 million members in Wisconsin, provided technology and information to augment IHN’s care management and data systems with the goal of helping medical providers lower costs, identify specific care gaps and provide real-time information about emergency room and inpatient admission to better manage a patient’s ongoing care.
“We’re trying to change the game by providing bonuses for quality improvement,” said Dustin Hinton, president and CEO of UnitedHealthcare of Wisconsin. “By working closely with providers, we can provide them with key data so they can help treat patients better.”
Arise Health Plan previously worked with several AboutHealth members, so it made sense to pull it all together, Kowalski said.
“It takes a lot of work. There’s a joint operating committee made up of all the health care systems as well as myself that meet monthly to move issues forward,” he said. “We also increased the number of counties in Wisconsin where we sell insurance – it’s up to 50 for 2016 – so our footprint overlaps that of AboutHealth.”
Arise also worked individually with one AboutHealth member, Aspirus Health, to create a co-branded health product.
“It’s a joint marketing agreement and really helps consumers better understand just who is delivering the care. It’s working well and attracts notice from consumers,” Kowalski said, adding that in 2016 Arise expects two-thirds of its individual exchange customers will live in the Aspirus service area where the co-branded product is offered. “We worked very closely with Aspirus over the past two years to achieve that outcome.”
Aspirus Network Executive Director Kathryne McGowan said that when healthcare providers and insurance companies come together, the patients benefit.
“It’s the right use of time, energy and money for us to work together and remove as many barriers to care as possible,” she said. “The co-branded product allows us to have more people on the same plan with the same benefits so we can develop programs that provide optimal care.”
While the state’s health care and insurance industries have witnessed plenty of change in the past few years, Kowalski predicted more to come.
“The market is changing so fast. It’s a challenge to plan past 18 months out,” he said. “It’s definitely not how it used to be.”
Building boom for Wisconsin insurers
There seems to be no stopping Wisconsin-based insurance companies when it comes to growth.
From Acuity in Sheboygan to Northwestern Mutual in Milwaukee, insurance firms are expanding their headquarters or building new ones.
A quick recap:
Northwestern Mutual is building a new headquarters in downtown Milwaukee that will total 1.1 million square feet when completed in 2017. The 32-story Northwestern Tower and Commons will keep 1,100 jobs downtown and provide room to add 1,700 more.
Construction crews continue to work on the $100 million expansion at Acuity Insurance. When completed, an estimated 450,000 square feet will be added, including a 65-foot Ferris wheel. When complete, the Sheboygan headquarters will be 50 percent larger.
Secura Insurance in Appleton is also looking at either expanding its current campus or building a new headquarters at another location in the Fox Cities. That project – like Northwestern Mutual and Acuity – is being driven by growth. Secura received $2.5 million in tax credits from the Wisconsin Economic and Development Corp. to help with an estimated $90 million in equipment and construction costs. The company is working with CD Smith Construction on a master plan and hopes to break ground next year.
In Merill, Church Mutual Insurance Co. renovated a former Wal-Mart in the city and will move about 200 of its 1,000 employees. The location includes offices, a fitness center and a cafeteria.