Maintaining local health plan choice is the state’s best option

by Dr. Mark Huth, CEO, Group Health Cooperative of South Central Wisconsin

Group Health Cooperative of South Central Wisconsin (GHC-SCW) holds a unique position in the State Group Health Insurance Program and the broader Wisconsin health insurance market. First, GHC-SCW is the only nonprofit consumer cooperative, staff-model HMO in the state. Also, GHC-SCW was one of the first managed care health plans to serve State Group Health Program members, and GHC-SCW’s quality rankings have been in the top echelon nationally and first in Wisconsin for many years. Our integrated structure has allowed us to innovate to better meet patient needs through multidisciplinary care teams and complementary medicine services.

GHC-SCW is taking an active role in opposing the State Group Insurance Board (GIB) proposals to self-fund and regionalize the State Group Health Program. We believe the current model of competition and choice is the best option for state employees, taxpayers and other purchasers of health insurance in Wisconsin.

Today, GHC-SCW serves more than 14,000 State Group Health Program participants, 12,000 of whom choose GHC-SCW as their medical home and have done so for more than 20 years. There are important reasons for their longevity, including GHC-SCW’s unique service model, starting with our caring physicians and staff. All patients who walk through our clinic doors are members—they appreciate belonging to an organization with a tradition of providing a seamless, efficient and affordable healthcare experience. They take comfort in knowing their care will be coordinated and of the highest quality, and they know they are part of a local organization that makes it easy to obtain the care they need.

Unfortunately, the proposed self-funding and regionalization proposals eliminate GHC-SCW as a choice for State Group Health Program participants. The structure of the request-for-proposals used to select vendors prevented GHC-SCW from participating. It is incongruous that a strategy whose primary goals were to lower costs and improve quality eliminates one of the lowest cost, highest quality health plans in the state.

GHC-SCW has a long history of partnership with the State Group Health Program and its participants. If given the opportunity to continue its current service model, GHC-SCW, and other health plans, could continue to develop innovative approaches to reducing costs and improving quality, as we did to save the state hundreds of millions of dollars over the past decade.

Under the self-funding proposal, GHC-SCW providers and clinics will be included as providers in other vendors’ provider networks. While we are grateful for the ability to continue serving state employees and their families in some capacity, it is clearly not equal to the experience members enjoy in the fully integrated, coordinated services of the staff-model health plan.

It is disappointing the GIB chose to stop several Wisconsin health plans from continuing to provide choice, higher quality care and lower medical costs for state employees and their families. We are pleased the Joint Finance Committee still has the ability to stop GIB’s mistake and maintain choice and competition for State Group Health Program participants, including the members of GHC-SCW. Maintaining choice and competition of local health plans is the right option for state employees, taxpayers and other healthcare purchasers.