Jeffrey Kluever
In my June column of The Catalyst, I provided an update on the development of Wisconsin’s first high-performance health plan solution in partnership with Centivo. This health plan solution, exclusively for BHCG member employers, features a primary care-centered model. Since June, I am pleased to say we have made substantial progress in health system and provider group contracting for our value, intermediate and broad networks. A number of member employers implemented the high-performance plan on January 1, 2022.
Addressing a significant problem
This is a business community and BHCG initiative for eastern Wisconsin to address a key issue in doing business in eastern Wisconsin, namely, health care in Wisconsin remains unaffordable for employers, employees and their families. The status quo is simply unsustainable.
We need to take costs out of the system. The way to do this long-term is to work directly with health systems and provider groups to create a plan that aligns our objectives and achieves our goals. We also know that strong relationships with primary care providers help plan members navigate the system and support them in making better health care choices to get the right treatment at the right time. We have an issue of medical homelessness among too many of our employees and their families who have no connections to a primary care physician. This new high-performance, primary care-driven model directly addresses this issue.
Provider network strategy
Centivo’s network development strategy is to work directly with health systems and provider groups to create a health plan that identifies high value providers and rewards those providers for value, not volume. The development of strong relationships with primary care providers helps plan members navigate the health care system. The result is better health care choices, a key element of the high-performance health plan solution.
Centivo was extremely successful in the development of the plan’s provider networks. Effective January 1, 2022, our three different network configurations in eastern Wisconsin – a value, an intermediate and a broad network – are outlined below:
- Value Network (WI-3): Ascension Wisconsin, ProHealth Care, Children’s Wisconsin, Prevea/HSHS and Independent Physicians Network
- Intermediate Network (WI-2): Ascension Wisconsin, ProHealth Care, Children’s Wisconsin, Froedtert, Prevea/HSHS, Medical College of Wisconsin and Independent Physicians Network
- Broad Network (WI-1): Ascension Wisconsin, ProHealth Care, Children’s Wisconsin, Froedtert, Advocate Aurora Health, Prevea/HSHS, Medical College of Wisconsin and Independent Physicians
Significant savings potential
Centivo projects employers can reduce their medical health care spend significantly by offering the high-performance plan networks. On average, employers offering the:
- Value network could anticipate saving 28 percent if the value network is the only one offered
- Intermediate network could anticipate saving 16 percent if the intermediate network is the only one offered
- Broad network could anticipate saving eight percent
Flexible network options and additional products
Centivo has joined forces with Health Payment Systems (HPS) to offer BHCG self-funded member employers the network option of HPS's traditional broad-based network for Wisconsin-based employees outside of eastern Wisconsin. Similarly, if member employers have employees located outside of Wisconsin, they may also access Cigna's national network. For employers interested in keeping their existing carrier, the Centivo networks can be offered alongside current health plan options.
BHCG and Centivo are also putting the finishing touches on a new product for member employers with onsite or near-site clinics. More details about this product can be found in the Did You Know? section of this newsletter.
Committed member employers
As I mentioned, a number of our member employers, including Baird, Northwestern Mutual, Sendik’s Food Markets, The Boucher Group, American Roller and The Guardian Life Insurance Company implemented the high-performance health plan solution on January 1. We have also received significant interest from other member employers, prospects and advisors in Wisconsin and commitments for 1/1/23 implementation from many others.
Representatives of committed employers had varying reasons to move ahead with Centivo. “The significance of partnering with providers to negotiate contracts where they are paid for quality and cost efficiency should not be understated. We are looking forward to the positive impact our work with Centivo will have on our health care costs and the costs to the community at large,” said Janet Lucas Taylor, senior director, employee benefits, Northwestern Mutual.
Added Lisa Mrozinski, director of total rewards, Baird, “Employers, often for the first time, can actually see the terms of the contracts put in place rather than being hidden behind the walls of an insurance carrier. As a major employer, Baird embraces this new option as we work to improve health care quality and cost efficiency for our associates and their families.”
With Centivo, our member employers can offer their employees high quality care at lower and more predictable costs, while at the same time saving significantly on their overall health care spend. This approach supports the BHCG mission of using the collective voice and knowledge of our member employers to lead change and create value.
If you would like more information about the BHCG-Centivo partnership and the network offerings or have questions, please feel free to contact me at jkluever@bhcgwi.org or 262-875-3312 X1.