Health Plan Tries to Get More for Less; Group Hopes Fee Caps Gain Wider Acceptance

Health plan tries to get more for less

Group hopes fee caps gain wider acceptance

Doctors and hospitals are realizing what businesses in southeast Wisconsin have known for years: Health care costs are out of line, said Dianne Kiehl of the Business Health Care Group of Southeast Wisconsin.

That’s progress, said Kiehl, who was hired six months ago to turn around the 50-member organization’s languishing health insurance plan.

“Finally, the health care providers and businesses agree we have a problem. That’s step one,” she said.

The next step? Working to get physicians and hospitals to lower prices, provide quality and price information and accept the caps on fees that businesses in the health care group are offering to pay.

Progress in those areas has been slow, she said.

Kiehl, a nurse and longtime health care industry executive in Wisconsin, was hired in June by the Business Health Care Group to jump-start its ailing health insurance plan. That plan proposes to pay physicians set, non-negotiable fees.

The controversial plan, which pays doctors fees that are below what other health insurers pay, has met with less than widespread enthusiasm from most physicians.

The fees are paid on a take-it-or-leave-it basis. Only about 20% of area physicians have joined the plan, which was formed in January 2003.

Kiehl said she has been trying to recruit more primary care physicians.

Founding companies include Rockwell Automation Inc.; Briggs & Stratton Corp.; Harley-Davidson Inc.; Midwest Air Group Inc., the parent of Midwest Airlines; Miller Brewing Co. and Journal Communications Inc., publisher of the Journal Sentinel.

So far, only 8,000 employees at Rockwell and Briggs & Stratton are required to be part of the plan, which pays doctors a maximum allowable charge, or MAC, as it is called. Journal Communications and Marshall & Ilsley Corp. offer the plan to employees as a health insurance option.

The business group has grown to 50 members from 43, and to 140,000 employees and their dependents from 110,000 employees and dependents six months ago.

Kiehl said she wants to expand the MAC plan to include ways to reduce the use of health care services, improve quality measures and workers’ lifestyles and to reduce unneeded health care programs in southeastern Wisconsin.

“We want to transform the health care delivery system,” she said.

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