Another option

Members of the Metropolitan Milwaukee Association of Commerce (MMAC) are finding a new option for employee health care insurance. The MMAC is partnering with Madison-based Wisconsin Physicians Service Insurance Corp. (WPS) to offer competitively priced health insurance to its members through the Patient Choice program.
Patient Choice is a consumer-driven health insurance plan designed to save money for employers by offering lower health insurance premiums and by encouraging their employees to reduce unnecessary doctor visits.
The introduction of the Patient Choice partnership coincides with the MMAC’s goal to develop private sector solutions to high health care costs, a goal outlined in the Blueprint for Economic Prosperity, the organization’s economic growth agenda and bi-annual report.
"Patient Choice will help consumers sort out the actual cost and quality of service provided," said MMAC president Timothy Sheehy. "It is designed to, over time, get employees to see that they have choices and the difference in cost-based on their choices."
Patient Choice evaluates health care providers by costs, quality and efficiency, Sheehy said. Based on those evaluations, the health care providers are rated and placed in one of three tiers.
The first tier is for the least expensive providers.
Employers decide the percentage of each tier they wish to cover, and employees decide which tier they want coverage under. Employees will have to pay more out of their own pockets to receive health care from providers in the higher-cost tiers.
WPS has offered the service to companies with more than 50 employees in southeastern Wisconsin since April. Recently, Patient Choice has been made available to MMAC members with between two and 50 employees.
In the new partnership, the MMAC can be a communication source for introducing and implementing Patient Choice for its members, said Bill Bathke, vice president of WPS.
"The greater Milwaukee chamber is a unique organization, where the Patient Choice product has some good applications," Bathke said. "Given the potential that the product has within the association, it warrants the offering to employers with less than 50 employees."
The MMAC currently has more than 2,000 member businesses in the greater Milwaukee area, Sheehy said. Firms with two to 50 employees will have to be a member of the MMAC to receive Patient Choice.
"Patient Choice is bringing a product to our members that they have never had access to before," Sheehy said. "There is difficulty in marketing consumer-driven health insurance to smaller employers, because larger employers have more options when purchasing, for instance, the power and ability to self-insure. Smaller employers are having trouble finding affordable health care."
Rising health care costs are a top priority for most members of the MMAC, Sheehy said.
"The noisiest issues by far right now are health care costs. Second is China," Sheehy said. "Ultimately, health
care costs are driven by price and use. More purchasing power means better quality and a decrease in price."
The MMAC hopes that Patient Choice will give employers a better tool in which to purchase health care, which will cause providers to react by improving health care quality, Sheehy said.
The provider network in the Milwaukee area includes Advanced Healthcare, Children’s Hospital and Health System, Columbia St. Mary’s Physician Network, Medical Associates Health Centers, Quad-Med, Covenant Provider Network and Waukesha Integrated Delivery System. Froedtert Health and the Medical College of Wisconsin are available on a market-wide basis, and most other providers are available through the WPS PPO Statewide network, Sheehy said.
The Milwaukee area is the first region in Wisconsin to have Patient Choice. WPS had successful results with a similar program called Minneapolis Patient Choice and modeled Patient Choice in Wisconsin after the Minnesota plan.
Bathke hopes that Patient Choice not only spreads across Wisconsin, but causes health care to become a consumer-driven market.
"I like to think that the individual would be much more aware of the costs and the quality of services needed," Bathke said. "I like to believe that the Patient Choice offering has long-term competitive premiums and that the quality of care that is being provided offers the best buy scenario on the part of the consumer."
Paul Sweeney, a partner at PS Capital Partners, LLC, switched his company’s insurance coverage to Patient Choice after hearing about the offering and comparing costs. Sweeney was initially introduced to the insurance plan because he is on the board of the MMAC’s Council of Small Business Executives (COSBE).
"I turned in census information and got back price information that was very attractive, relative to what we had been currently paying with UnitedHealthcare," Sweeney said.
PS Capital Partners is a private equity investment company that consists of Sweeney and his business partner, Paul Stewart. With the way the program is structured, they could keep the same physician they already had, Sweeney said.
The same would hold true for a company with 50 or more employees, Sheehy said, because the employee can choose to continue coverage with his or her physician, as opposed to having an employer switching insurance coverage with certain physicians not covered.
"My monthly premium is lower and I have improved my coverage," Sweeney said. "What I personally like about the program is that it is putting more of a choice in the employees’ hands, so if you want to see someone in the higher-tier category, then it is your choice to pay the higher cost."
PS Capital Partners gained 10 to 15 percent in cost savings by switching to the plan, Sweeney said.
"This is all designed to have lower percentage premium increases than other programs, and between the savings based on my old premium and with the percentage United was increasing, I would envision we would stay with Patient Choice for a long time," Sweeney said. "As an MMAC member and a small-business owner, this has made a tremendous amount of sense."
January 7, 2005, Small Business Times, Milwaukee, WI