Medica focuses on long-term value in Wisconsin

Four-and-a-half years ago, Minnesota-based Medica and Dean Health Plan finalized a strategic partnership.

Since, they’ve focused on addressing community needs, leveraging technology and enhancing care delivery, said Medica Wisconsin Market President Josh Gustafson.

“When is there a finish line?” Gustafson said in an interview with Wisconsin Health News this week. “There never really is. You have to keep evolving.”

Medica, Dean Health Plan by Medica and Prevea360 Health Plan cover more than 350,000 Wisconsinites.

“As systems get more complex, our goal is to figure out how to make it easier,” Gustafson said.

Edited excerpts from the interview are below.

WHN: Are you looking to expand in Wisconsin? 

Gustafson: We go where there are opportunities for partnerships, and we go where communities need us, or they need another choice that’s like us. As you’re talking about expanding or serving more individuals, it is not in our business model to plop a flag somewhere, offer this broad network and let people do as they should. Continuity of care, coordination of care and the deep partnerships that we have, just like with several of the other HMOs, that’s where we bring value.

So our approach in Wisconsin is, number one, go where the communities need us. That’s both in products, but it’s also in community support. Not too long ago, we made a significant investment in the Fox Valley. There was a federally qualified health center that had a solid business plan where they could serve more people, but they did not have the funding for the expansion of community health workers to get outside their walls and serve other micro-communities within the larger communities. They needed $400,000, so we provided that investment to them. We don’t exist there, but it’s the right thing for the community. The microeconomics of that supports the larger economics across Wisconsin.

The other number one thing that we keep top of mind when we’re looking at different areas, communities that need services or regions of the state is making sure that as we go there, we are not doing anything to people. Potentially, we’re never doing anything with people. We’re doing things for people. The only way you can do that is making sure that there is alignment between the payer, the provider and the other resources that fit those other components of social determinants of health within that region.

When you have people at the table and you are all working together and having regular active conversations, even potentially sharing in the risk, a different level of accountability, resources, excitement, energy and strategy come with it.

WHN: What do you see as the pressing healthcare issues in Wisconsin? 

Gustafson: People aren’t just looking for coverage. The messages are loud and clear: They need guidance. The systems are getting more complex. There’s continued (merger and acquisition) activity across the country. People need to actually be cared for, as opposed to having coverage. Our members are at the center of what we do, but our goal is to never put them in the middle.

The cost, the complexity, the access to care are causing real strains on the healthcare system. Solving that requires collaboration across the entire industry.

WHN: What is Medica doing to address affordability? 

Gustafson: I’ll go right back to those partnerships that we have with healthcare delivery systems. We have data, and they have data. They have medical records, and we have claims data. We have the opportunity to not just extract that raw data, but to use that data to make data-driven decisions and partnerships with the healthcare systems where we’re doing it on the front end with predictability, as opposed to each side having their own data and not sharing it.

We have an extensive affordability team across Medica, headquartered out of Minnesota, but the resources are shared and utilized across all of our states. That has brought additional value that we have not had before.

WHN: Wisconsin saw a dip in enrollments in the Affordable Care Act marketplace following the expiration of enhanced subsidies at the start of the year. What are you seeing in the market? 

Gustafson: We expect further erosion through 2026 and going into the next open enrollment period, primarily related to potentially healthy individuals losing subsidies. That may further drive up morbidity levels of the people who are remaining, so you can make that prediction. It’s a downward cycle.

We are getting out ahead, we are making predictions and we are making appropriate changes and adjustments because the worst thing you could do right now, as these pressures are coming on, is have carriers completely exit several counties and areas across the state and leave people without coverage.

WHN: Are you planning to stay in the ACA market? 

Gustafson: We have no plans on a mass exit. As you saw in 2026, we had no changes. Moving forward, we are still here to serve. We are mission-driven. Our healthcare system partners are mission-driven. Medica has done an amazing job over 50 years in managing through the peaks and the valleys of everything that’s happened in our space and across healthcare. That puts us in a strong position to make sure that when we hit another valley like we are in right now, we can continue to serve.

In some cases, there are carriers who either don’t have that ability or they don’t have an appetite to, and they might enter several counties one year and, within 12 to 24 months, they exit those same counties. Stability is absolutely a necessity for these people to make sure they have coverage, so they can get care when they need it. From our stance, it would not be responsible of us as stewards of a nonprofit supporting the community to be going in and coming out.

WHN: What’s next for Medica? 

Gustafson: We are always evaluating opportunities. That will not stop, and that’s opportunities to serve more individuals.

One, it has to align with our mission. Two, it has to make sense for Wisconsin.

The focus also has to be on long-term value. It does no one good if we make a quick decision and we go somewhere, do something different, change a product or launch something, and it provides short-term value, but then it gets stripped away. We have to have that long-term value. We don’t focus on growth for growth’s sake. We focus on making sure that when we go somewhere or provide something different or something new, that it’s something that’s going to be there for a very long time.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.