By Guy Boulton of the Journal Sentinel
May 30, 2014
Quality Health Solutions Inc., a consortium of health systems, hospitals and physicians that includes three of the health systems in the Milwaukee area, has changed its name to Integrated Health Network of Wisconsin and expects to move forward this year with offering its network to health insurers and employers.
“We are right on the verge of doing this,” said Peter Pruessing, chief executive officer of Integrated Health Network.
The consortium includes Froedtert Health, the Medical College of Wisconsin, Columbia St. Mary’s and Wheaton Franciscan Healthcare. Other members include Agnesian HealthCare, and Ministry Health Care.
Integrated Health Network also said that it has signed an agreement with FlagshipSailsRx in Waukesha to offer a health plan to employers with 20 or more employees who self-insure, or pay most of the medical claims of employees and their families.
Employers who self-insure buy insurance, known as “stop-loss” coverage, to pay for medical bills above a set amount — basically health insurance with very high deductibles.
Integrated Health Network will be able to offer employers better rates on that coverage, Pruessing said.
The network — what is known as a commercial accountable care organization — includes more than 4,500 physicians, 450 clinics and 34 hospitals in northern, central and eastern Wisconsin.
Accountable care organizations are accountable for the cost and quality of care for a defined group of patients. In exchange, physicians, health systems or both share in any cost savings provided they meet specific quality measures.
The goal is to give doctors and hospitals a financial incentive to focus on how they deliver care rather than on revenue.
The current system, known as fee-for-service, typically rewards hospitals and doctors for providing more services — procedures, imaging tests, office visits — that may not improve a patient’s health. At the same time, doctors and nurses often aren’t paid for care that would benefit patients, such as working closely with a diabetes patient to help manage his or her disease.
In some ways, the current system penalizes doctors and hospitals when they provide better care at a lower cost. Not ordering an unneeded or inappropriate test, for instance, costs doctors and hospitals revenue. And the same holds for when providing better care keeps a patient out of a hospital.
Aurora Health Care also has set up an accountable care organization and has reached agreements with Aetna Inc. and Anthem Blue Cross and Blue Shield in Wisconsin to offer health plans tied to its network.
Aurora is guaranteeing savings if employees and their families use Aurora’s network of hospitals and doctors for nearly all their care.
The health system indirectly would pay for any costs above the guarantee. At the same time, Aurora would be eligible for bonuses if costs increase less than projected and it meets certain quality measures.