By Cheryl DeMars, President & CEO, The Alliance, Madison, Wis.
Employers are working together to make a difference in the cost and quality of health care. The innovations that result are helping improve health care for everyone.
I shared three examples of employer innovations in testimony to the Senate Committee on Health, Education, Labor and Pensions (HELP) on Nov. 28.
Creating Purchasing Power
Employers can change the local health care marketplace by pooling their purchasing power to contract directly with doctors, hospitals and other health care providers.
The Alliance was founded for this purpose. Our average employer size is about 400 employees, yet together we spend $787 million on health care every year. Our goal is to buy health care based on value – balancing quality and appropriateness with cost.
We contract directly with hospitals and clinics to create a network of providers that gives employees access to the doctors and hospitals they want to see at competitive prices. Our contracts also let us share prices with employees and protect them from balance billing.
Worksite Primary Care
“Primary care” is used to describe the doctors and other caregivers who are your first point of contact with the health system and who manage your ongoing care.
“High value” primary care helps people get preventive care in a timely way and manage health problems that need ongoing care, such as diabetes. Some employers create their own primary care clinics at or near the work site to ensure employees get high-value primary care.
Flambeau, Inc., in Baraboo, Wis., spent $7,900 per employee per year on medical care and prescriptions before opening an onsite clinic in 2012. Five years later in 2017, they spent $7,950, an increase of only 0.6 percent.
Directing Employees to High-Value Care
One of the fastest ways to improve the value of health care is to use providers who deliver good care at a lower price. That’s why The Alliance developed the QualityPath® program, which saved our employers more than $1.5 million in its first three years.
QualityPath uses lower out-of-pocket costs – sometimes nothing – to encourage employees to use high-value providers for “shop-able” surgeries and tests, like knee and hip replacements, CTs and MRIs.
Hospitals and doctors apply for the program and must prove their quality, adopt processes that lead to better outcomes and agree to a lower bundled price backed by a warranty.
The Alliance also works with NOVO Health to offer outpatient bundles to employers. Having bundle providers in-network helps us provide sustainable, predictable pricing for Alliance members.
Why It Matters to You
The impact of these innovations is often felt by all patients, not just those employed by an Alliance member. For example, hospitals that participate in QualityPath® must use the same processes for all patients.
When employers band together, they can make a big difference in the value of health care. Following their example can help us make health care more effective and more affordable for everyone.
Cheryl DeMars, President & CEO
Cheryl DeMars joined The Alliance in 1992, assuming several roles before becoming CEO in December 2006. Cheryl works with the Board of Directors and senior leadership team to establish the strategic direction of the cooperative. DeMars participates in a number of national and regional initiatives that align with The Alliance’s mission of controlling costs, improving quality and engaging individuals in their health. She serves on the Advisory Board of the Wisconsin Population Health Institute, the board of the Wisconsin Collaborative for Health care Quality, and is vice chair of the Wisconsin Health Information Organization (WHIO).
The Alliance (www.the-alliance.org) is an employer-owned, not-for-profit cooperative that moves health care forward by controlling costs, improving quality and engaging individuals in their health. Its more than 240 employer members provide health benefit coverage to more than 85,000 people in Wisconsin, Illinois and Iowa.
View a video of DeMars’ testimony or read her full written testimony at https://www.the-alliance.org/blog/alliance-senate-testimony-2018.