The Business Health Care Group, a benefits coalition group of Milwaukee area employers formed to help drive down the cost of health care in the region, recently discontinued its coverage for all Columbia St. Mary’s facilities in southeastern Wisconsin and has added the Wheaton Franciscan Healthcare system to the exclusive Humana Preferred Network.
he change, which will go into effect Jan.1, 2012, affects nearly 115,000 people.
“Every three years Humana asks providers to submit a request for proposal (for inclusion in the network),” said Dianne Kiehl, executive director of the Business Health Care Group. “We evaluate those proposals in a consistent manner and reconfigure the network accordingly.”
Kiehl declined to comment on the specifics of the evaluation, saying only that the evaluations were made in concordance with the group’s mission statement to control costs and provide the most value for network members.
Louisville, Ky.-based Humana Inc., in a letter to Business Health Care Group members, said that its new Humana Preferred Narrow network provides members with a, “broad choice of locations, hospitals and physicians throughout southeast Wisconsin.”
Wheaton facilities now included in the network are: All Saints; Elmbrook Memorial; Wheaton Franklin; St. Francis; St. Joseph; The Wisconsin Heart Hospital; and the Midwest Orthopedic Specialty Hospital. In addition, hospital systems that will continue to be a part of Humana Preferred Narrow network include: Aurora Health Care; Beloit Health System; Children’s Hospital of Wisconsin; Fort HealthCare; Froedtert Health; Mercy Health System; ProHealth Care; St. Nicholas Hospital; United Hospital System; and Watertown Regional Medical Center.
Columbia St. Mary’s facilities, including CSM Milwaukee, Sacred Heart Rehabilitation Institute, CSM Women’s Hospital, CSM Ozaukee, and The Orthopedic Hospital, will be considered out-of-network for Humana HPN members beginning Jan. 1.
In a statement, Columbia St. Mary’s indicated that losing the Business Health Care Group membership will not have a significant impact on its business.
“Columbia St. Mary’s is clearly disappointed that the Business Health Care Group has excluded Columbia St. Mary’s from the Humana HPN Narrow Network,” the statement said. “While this does not have a large impact on our business, it does have a significant, personal impact on our patients. This decision will disrupt patient/physician relationships that have been established for many years. We have provided exceptional care to Business Health Care Group patients since its inception, and we’re proud of our role as the region’s lowest cost provider.”
In response to Columbia St. Mary’s statement, Kiehl said all proposals went through an evaluation process and decisions about which providers to include in the network were made based on what would “create the most value” for Business Health Care Group members.
The changes made to the network will continue through Dec. 31, 2014, Kiehl said.
