Business Health Care Group of Southeast Wisconsin AAPPO Roundtable

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Business Health Care Group of Southeast Wisconsin
AAPPO Roundtable

• May 11, 2005

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Agenda

• What is BHCGSW?
• Historical Overview
• Membership Structure
• BHCGSW Goal
• Consolidation of Administration
• Partnerships
• Success Drivers
• Ultimate Goal

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BHCGSW What are we?

• The business communitys voice and collective
  action group for influencing the direction of
  health care cost and quality in our region.
• Benjamin Franklin Solution

We must all hang together, or assuredly we shall
all hang separately.
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Don Davis, Chairman EmeritusRockwell Automation

• This effort by large and small businesses alike
  is a great way to get serious about finding
  workable solutions to the problem of escalating
  health care costs and to help sustain businesses
  in our region.

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Historical Overview

• Started by CEOs with continued CEO leadership
• Incorporated January 9, 2003
• Limited Liability Corporation
• Hired Executive Director, June 2004
• Approximately 145,000 member lives (10 plus
  growth in 2004)
• Purpose BHCGSW focuses its collaborative efforts
  on promoting health care consumerism, reducing
  the cost of health care and providing employees
  access to quality and cost effective services by
  pooling common interests, efforts and purchasing
  power.
• Initiatives
• Established BHCGSW website
• Maximum Allowable Charge MAC
• Disease Management Collective
• Lab Card Collective
• Support for Quality Initiatives
• Provider Day

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BHCGSW Members Structure

• Member Companies
• Badger Meter
• Brady Corporation
• Briggs Stratton
• Simplicity
• Bucyrus International Inc.
• DaimlerChrysler Corporation
• Direct Supply
• Everett Smith Group
• Harley-Davidson
• Husco International
• Johnson Controls, Inc.
• Joy Global
• Journal Communications
• Ladish Company
• Manpower
• Jefferson Wells
• Marshall Ilsley Corporation
• Midwest Airlines

• Steering Committee
• Mary Jane Hall Rockwell Automation (Chair)
• Harold Scott Harley-Davidson
• Paul Renard Marshal Ilsey Corp.
• Dan Harmsen Journal Communications
• Tracey Joubert Miller Brewing Co.
• Mike Oliver Brady Co.
• John Couper Charter Mfg.
• Benefits Sub-Committee
• Quality Sub-Committee
• Labor Management Sub-Committee
• Communications Sub-Committee

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Operating Charter

• The Company shall be comprised of employers and
  employer groups located in the Southeast
  Wisconsin seven county region of Milwaukee,
  Ozaukee, Washington, Waukesha, Walworth, Racine
  and Kenosha counties (the Covered Region) who
  share a mutual objective to reduce the cost of
  health care and provide their employees with
  access to quality and cost-effective health care
  services by pooling their common interests,
  efforts and purchasing power. To achieve this
  objective, the Company will be managed and
  operated by its Steering Committee to promote
  cost-competitive and quality health care services
  throughout the region by effectively
  implementing, among others, the following
  actions
• Promote health care consumerism among employees
  and mechanisms to accomplish this may include
  changes in program design, employee education and
  communication with health care providers
•  
• Provide employees with increased flexibility and
  more desirable choices in their health care
  service options and
• Effectively secure, analyze and disseminate
  statistical data and information regarding the
  cost, quality and availability of health care
  service options.

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Goal of BHCGSW

• Develop market driven health care delivery system
  in
• Southeastern Wisconsin through
• leveraging purchasing power
• structuring accountability from consumer,
  employer, administrators and providers
• creating data transparency
• supporting consumers

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Supporting Concepts

• Standards for quality need to be set and measured
• Not obligated to support all infrastructure
• Cost of health care includes unit cost,
  utilization, quality and system infrastructure
• Consumer accountable for healthy lifestyle,
  compliance with treatment plan, appropriate usage
  of resources as educated
• Physicians accountable for quality of care
  delivered, compliance with best practice,
  appropriate resource utilization, cost controls,
  prospective pricing and support for data
  transparency
• Systems/Groups accountable for quality of care
  delivered, infrastructure cost control,
  prospective pricing, operational efficiency and
  support for transparency
• Employers/Health Plan Sponsors accountable for
  educating consumers, aligning benefit plans to
  support market competitive model and consumerism,
  coverage for wellness, collaboration with
  providers, providing useable data to consumers
• Administrators accountable for speedy accurate
  payment of claims, collaboration with BHCGSW to
  meet region goals, methodology for provider
  evaluation, providing consumer information in a
  useable format

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BHCGSW Selects Humana Inc. to Develop a New
Health Program for Members

• The Business Health Care Group of Southeast
  Wisconsin (BHCGSW) recently announced that it
  will work with Humana Inc. to develop a new
  health program for the organization that
  represents more than 135,000 consumers in
  Southeast Wisconsin.
• Business Journal

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Why Consolidate Administration?

• Means to End
• Collective purchasing
• Centralized data
• Consistent message to providers and consumers
• Ability to develop and implement true partnership

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Decision Parameters

• Existing Provider Contracts
• Clinical Quality Interventions
• Transparency
• High Performance Network
• Partnership
• Administration Fees
• Fully Insured Product

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How will we get there?

• Partnerships with
• Consumers
• Providers

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Consumer Engagement

• Education
• Tools
• Feedback

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Plan Design

• Objectives of Designs
• Incent employees to select higher performing
  providers
• Increase employee sensitivity to real cost of
  health care services
• Increase employee motivation and demand for
  information about what they are receiving with
  their own money (Value Transparency)
• Heighten employee awareness regarding care
  options and true need for services self care
  and discretionary health care spending
• Shift perspective of consumer risk factors from
  short-term to long-term

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Provider Day (12/8/04)

• Acknowledged cost per unit problem
• Status quo is unsustainable
• Solution will only come through partnership
  business community, providers, administrators,
  and consumers
• Consistent theme of greater consumer
  accountability/involvement in financial and
  health care decision making
• General agreement that provider performance
  transparency (both cost and quality) are
  essential elements for sustainable, positive
  change

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Provider Partnership Criteria

• Efficiency
• Effectiveness (quality)
• Unit Price
• Price Structure
• Transparency
• Sub-selection
• Wisconsin Collaborative for Healthcare Quality
• Cost Control Accountability

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Success Drivers

• Membership growth
• Choose provider partners that are aligned to
  BHCGSW goals
• CEO involvement
• Stamina to make decisions needed to drive the
  market
• Develop true partnerships

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Ultimate Goal - Value Based Purchasing

• Competitive Market
• Provider performance measurement
• Transparency
• Consumer engagement
• Differential payment

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BHCGSW

• Looking for progress not perfection!