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  • December 14, 2016 3:33 PM | Anonymous
    December 14, Wisconsin Health  News


    The Group Insurance Board delayed a decision Tuesday on changes to the health plan for state employees, including whether to shift to a regional or self-insurance model. 

    Chair Michael Farrell said the board has directed Department of Employee Trust Funds staff and Segal Consulting to gather more information and data about the proposals. The board will reconvene in January. 

    "There is much complexity and volumes of information that relate to our consideration," he said. "We're not taking these decisions lightly."

    During closed session Tuesday, members weighed seven scenarios offered by ETF staff, according to a memo. 

    One proposal could continue the current fully insured model with minimal changes. That model would have up to 16 different vendors participating. 

    Other scenarios under consideration would have between six and 11 participating vendors. Those proposals could be fully insured, self-insured or a hybrid. Some of them would divide the state into regions. 

    A seventh proposal, which is not recommended by ETF or Segal, would have one or two vendors under a self-insured model. 

    The board has been considering self-insurance off and on for five years according to the memo. It's also considering other changes like three-year contracts with health plans. 

    Phil Dougherty, spokesman for the Wisconsin Association of Health Plans, said his members "recognize that more can be done in the current competitive model to achieve the state's financial and quality goals."

    "Moving to Segal's regionalization strategy would create the risk of reducing competition and choice, eliminating high quality healthcare networks and separating plan participants from their doctors and medical homes," Dougherty said in a statement. "The right answer for the state is to use the current competitive structure and Wisconsin health plans to build on what works."

    Read a summary memo on the proposals and discussion.

  • December 14, 2016 12:46 PM | Anonymous

    Major changes are likely in store for the country's healthcare system. Obamacare, Medicaid and Medicare could all be in for overhauls. 

    How far will lawmakers go? Will people with pre-existing conditions get to keep their coverage? What about the 22 million Americans, and 200,000 Wisconsinites, who have gained health insurance? How would the industry react to a transition period? Are they ready to start over?  Learn more at a Wisconsin Health News Panel Event Jan. 12 at the Madison Club.  Panelists include: 

    • Eric Borgerding,CEO, Wisconsin Hospital Association
    • Coreen Dicus-Johnson, CEO, Network Health Plan
    • Donna Friedsam, Health Policy Programs Director, University of Wisconsin Population Health Institute
    • Mike Wallace, CEO, Fort HealthCare.
    Register now.
  • December 11, 2016 8:48 AM | Anonymous

    Building off record attendance at Doctor Day 2016, specialty societies and the Wisconsin Medical Society are expecting to draw another record attendance at the 2017 Doctor Day.  The event is scheduled in Madison on March 29.  Click  here  for a list of participating organizations. 

    This annual advocacy event is timed well for physicians to be able to meet with their legislators and/or staff members, and to have input on the budget and other important health care issues. Participants will hear from Medicaid Director Michael Heifetz of the Wisconsin Department of Health Services and others, then will take part in an issue briefing before heading to the Capitol. Lunch will be provided, and the day will conclude with a reception in downtown Madison. 

    Visit the Doctor Day  website  for more information and to register.

  • December 08, 2016 12:43 PM | Anonymous

    Wisconsin Health News

    Rep. Joe Sanfelippo, R-New Berlin, will continue to chair the Assembly Committee on Health next session, according to a Wednesday statement.   Rep. Samantha Kerkman, R-Salem, will serve as vice chair of the committee. 

    Assembly Speaker Robin Vos, R-Burlington, also reappointed Rep. Paul Tittl, R-Manitowoc, to serve as chair of the Assembly Committee on Mental Health. Rep. John Jagler, R-Watertown, will vice chair the committee.  Rep. Tom Weatherston, R - Caledonia, will chair the Assembly Committee on Aging and Long-Term Care. Rep. Warren Petryk, R-Eleva, will vice chair that committee.  Rep. Kevin Petersen, R-Waupaca, was tapped to chair the Assembly Committee on Insurance and Rep. Cindi Duchow, R-Delafield, was picked for vice chair. 

    Vos also announced new committees for next session, including one focused on science and technology and one on regulatory licensing reform. See more committee leadership appointments.

  • December 08, 2016 8:49 AM | Anonymous

    December 1, Wisconsin Health News 

    Group Insurance Board members questioned the amount of savings the state receives under its current health insurance model and called for increased access to data as they discussed a possible move Wednesday to self-insurance. 

    Michael Heifetz, state Medicaid director, said the board needs better access to data to make sure they're providing the best care at the best price to employees who "have more skin in the game - a phrase I hate but gets used all the time - than they ever had before.” 

    "We need data to know if we are getting the best deal and to know if we are getting the best quality," he said. "For us not to have that control and to rely on the vendors puts us at a disadvantage." 

    The board selected Truven Health Analytics to serve as its data warehouse vendor at the meeting. But Heifetz noted that if the board doesn't have "any actual good data to shove into that data warehouse, it's not going to help us very much."  

    "Folks can analyze the self-insured vs. fully insured model, but if we don't have data, whatever decision we make is not well-founded," he said. "Politics at the national level have changed. Great. Maybe the Affordable Care Act goes away, maybe it doesn't. This board's mission hasn't changed and we still have to ensure high quality at a reasonable price for our members. And again, it takes data to do that."  

    He questioned the $283 million in cost reductions over the last nine years under the current model, described in a memo prepared by the Department of Employee Trust Funds. The reductions were determined by the difference between the preliminary and final bids by health plans.  

    "Without the right data, I don't know if those initial bids are great numbers or not, or if it's 'Let's see what the state will give us or not,'" said Heifetz, a former lobbyist for SSM Health Care of Wisconsin. "I've been on the other side of this to some degree and that number keeps being thrown at us as if it's sacrosanct and absolute. And I simply don't accept that premise."  

    He said it's "pretty self-serving" for someone to provide a number, then lower it and "tell us how much they saved," he said. "We don't know if we really saved that much."  

    Heifetz added that "a piece of me would love" to have the discussion on self-insurance held in open session, rather than the closed session the board held Wednesday afternoon.  

    "There are folks who will criticize us for being in closed session even though it's all proprietary things that they probably wouldn't want aired in the public arena," Heifetz said. "I have mixed emotions about going into closed session to discuss these things. I am a member of the public, I'm a taxpayer and I'm a member who gets benefits for my family through this process." 

    Phil Dougherty, senior executive officer for the Wisconsin Association of Health Plans, noted that health plans' rates for the State Group Health Program match the healthcare risk they cover. 

    "Driven by the market competition structure of the program, annual premium increases for the program over the past nine years averaged 3.7 percent, significantly below the national trend," he wrote in an email. 

    The state's decision to contract with Truven will provide data to ensure it gets competitive rates from health plans serving the program, he added.  

    J.P. Wieske, deputy insurance commissioner, noted that the average costs of the plans sold on the state's individual exchange are cheaper than those sold though the employers' exchange.  

    "Some of these carriers in Milwaukee and Dane County are carriers in the exchange as well," he said. "And the fact that their rates have been lower in the exchange than the employee plan is really surprising given the risks. I don't believe the population inside the exchange, especially with the problems that they have, especially with how (the Department of Health and Human Services) has administered it, the health of that individual market is probably worse than the state employee population, which is stable, large and consistent."  

    Herschel Day, a professor at the University of Wisconsin-Eau Claire, said that part of the problem could be that members are insulated from the carriers. He noted that they pay the same amount for plans in the highest tier regardless of how plans charge and called for more transparency.  

    "Folks can see what the actual premiums charged are, but given that there's no impact within Tier 1 for the member, I think in some sense we're insulating them from that difference," he said. "That could feed into the higher rates."

  • November 28, 2016 8:52 AM | Anonymous

    November 17, Wisconsin Health News

    The Medical Examining Board approved a revised version of a rule defining telemedicine Wednesday. It now heads to Gov. Scott Walker's office and then the state Legislature for approval. 

    The board has spent the last year drafting the rule, scrapping its original proposal after healthcare providers raised concerns. The final rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on equipment and technology as well as internet diagnosis and treatment.

    "The two different versions of the telemedicine rule are pretty stark," said Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society. "One was super-detailed and lengthy, the other one is much more flexible and probably useable by the board itself." 

    The Alliance of Health Insurers also backed the rule. 

    "Telehealth is a means to improve upon the high-quality healthcare system we already enjoy, particularly by improving patient access, regardless of distance and mobility," Executive Director R.J. Pirlot wrote in testimony. 

    Claudia Tucker, vice preisdent of government affairs for Texas-based TelaDoc, said they're pleased that the board accepted their recommendations to address HIPAA concerns and said they also support the latest version of the rules. 

    But some testimony questioned whether the rule could be construed to prohibit other healthcare professionals from providing care through telehealth. 

    Linda Roethle, vice president of regional business development at Bellin Health, said that more than just physicians and physician assistants should be covered under the rule, including nurse practitioners, clinical psychologists and clinical social workers. 

    "Please do not create any additional barriers for patients," she wrote in her testimony.  

    Tine Hansen-Turton, executive director of the Convenient Care Association, recommended language stipulating that nurse practioners can practice telehealth. The association represents clinics located inside retail locations like grocery stores and pharmacies. 

    "Wisconsin's retail clinics are primarily staffed by nurse practitioners," Hansen-Turton wrote. There are 35 retail clinics in the state, according to her testimony

    Dr. Kenneth Simons, board chair, said the board can't create rules for professions it doesn't oversee.  

    Read the rule.

  • November 24, 2016 8:53 AM | Anonymous

    November 14, Wisconsin Health News

    Doctors who prescribe controlled substances will have to complete training relating to the Medical Examining Board's opioid guidelines under a rule that went into effect Thursday. 

    The Department of Safety and Professional Services signed off on the emergency rule last week. It requires doctors renewing their licenses to complete two hours of training on the guidelines out of their 30 hours of bienniel mandatory continuing medical education.

    Read the rule.

  • November 10, 2016 8:56 AM | Anonymous

    November 2, Wisconsin Health News

    The state collected 58,729 pounds of unwanted medications and prescription painkillers during a national prescription drug take back day on Oct. 22, the Department of Justice said Tuesday. 

    The state's also increased the number of registered permanent medication return boxes in the state to 295. That's nearly double the 152 in September 2015.  

    "The fight against this epidemic isn't over, but with continued effort from citizens, we will save lives," Attorney General Brad Schimel wrote in a blog post. 

    In late April, the state collected 62,618 pounds of prescription drug. The amount of collected drugs at that point was third in the nation, behind California and Texas.

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