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Agent and Consultant Briefing: February 2011

On My Mind: Wisconsin’s New Health Cost Transparency Law

This month a new health care transparency law took effect in Wisconsin. The law requires:

• Hospitals to share median charges and estimated payments for private insurers and Medicare for the 75 most common diagnoses and the 75 most common outpatient surgical procedures.
• Physicians and other health providers to release similar cost information for the 25 most common conditions, beginning March 1. Other health providers are subject to the bill’s requirements, but are not included in the state’s implementation plan for 2011.
• Hospitals and clinics to let patients know how to obtain quality data if they report it to quality organizations.
• Hospitals and clinics to post signs in prominent locations about the right to receive this information.

Since disclosure of cost and quality information is central to the mission of The Alliance, we were asked to provide input to help shape the bill. Feedback from The Alliance Health Policy Committee was reflected in the final version, however the final law fell short of providing the information consumers really need to make informed health care decisions. Ideally, consumers would have one Web-based resource to enable them to compare meaningful cost and quality information from provider-to-provider and hospital-to-hospital.

What about Quality?
Information about cost without information about quality can be misleading. In health care, cost and quality are not correlated — and as we’ve seen in our own QualityCounts™ reports, high-cost providers do not necessarily deliver the best quality care, nor do low-cost providers deliver poor care. The new law gives a nod to quality information by requiring that if a provider submits data to a “health data organization” and if that data is then publicly reported, the provider is required to either share the information by attaching it to the financial information or by providing a Web address where the results can be found. This voluntary, self-reported process creates the potential for providers to “cherry pick” the quality information they disclose to consumers.

We will continue to work — inside and outside of the Capitol — to improve the transparency of cost and quality information and to develop strategies to promote its use. If you have any questions or comments about the new law, please contact me.

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Retaining Discounts with the UW and its Associated Entities

Timeliness of payment language ensures our members and their enrollees receive Alliance discounts. In 2010, third-party administrators’ (TPAs) failure to comply with this contract language in our agreements with UW Hospital, UW Medical Foundation, and Chartwell Midwest Wisconsin resulted in $397,000 in lost discounts for Alliance members. We will continue to work with TPAs to stress the importance of adhering to these provisions, but we encourage you and our mutual clients to speak to the TPA as well. Please read on for more information.

Services at UW Must be Paid for within 30 Days to Receive Alliance Discounts
Timeliness of payment language requires that payment for services at UW Hospital, UW Medical Foundation, and Chartwell Midwest Wisconsin must be received at the UW within 30 days of receipt of the claim by The Alliance.

If payment is not received within the required timeframe, the contract rate is void and the payer is responsible for 100 percent of billed charges. This means that enrollees and the member organization are not able to take advantage of our negotiated contract rate.

Ensuring Payment is Received within 30 Days
To ensure members have access to negotiated rates, The Alliance reprices claims received from providers within three days of receipt and passes them on to the TPA for payment. In 2010, we processed 99 percent of all claims within three business days, but our average turnaround far exceeds this contracted promise. Our average turnaround for UW claims was:

• Electronic (99.45% sent this way) – 0.00 days
• Paper – 1.69 days
• All claims – 0.10 day

"Clean claims" are defined as claims with all the proper fields completed with sufficient information for The Alliance to reprice the claim. This includes claims that may be delayed in the payment process because itemizations, questionnaires, medical records, subrogation, reinsurance, third-party liability, or other items are needed. All claims sent from The Alliance are "clean claims" under terms of our agreements. These claims must be paid by TPAs within 30 days, but many TPAs are failing to do so.

We have provided repeated education to TPAs about the 30-day time period to minimize the financial impact to members. We have notified them that it begins on the day The Alliance receives the claim for repricing and ends on the day the UW or its associated entities receive payment. Many continue to assume that the 30-day time period starts on the day the claim is received by the payer and end when the check is dated.

We provide TPAs with a weekly report of all impacted claims repriced to help them to manage their inventory and ensure claims are paid within the provisions of the agreement.

We have also informed TPAs if they are in doubt to pay the claim, since the timeliness of payment provision includes a guarantee of a timely refund, as long as the request occurs within 6 months of payment.

We recognize the role our member organizations play in influencing their TPA’s compliance. We have encouraged them to speak with their TPA to ensure they are making these payments in the 30-day timeframe to help them take advantage of Alliance negotiated rates. We also encourage you to speak to the TPA on our members' behalf. For more information, you may direct TPAs to this article. If you have questions, please contact Jesse Oberloh, 800.223.4139 x 6645.

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Earn up to 8 CE Credits in One Day at Agent/Consultant CE Day

The Alliance is hosting a one-day event where you can earn up to eight continuing education credits. Space is limited, so register today if you are interested. You can attend as many sessions as you want and there is no cost to attend. Sessions include:

• Specialty Pharmacy and Considerations for Plan Sponsors
• Ethics
• How to Evaluate Health Networks
• HSAs and Financial Wellness – A Holistic Approach

Learn more (.pdf) and register today.

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Coping with Stress and Change at the Worksite Materials Available

Dr. Brian Luke Seaward provided Alliance members and guests with a humorous and thoughtful look at the impact of stress on the workplace at our Alliance Learning Circle on January 20.

Materials, including slides, handouts and an executive summary from the event are now available In the Circle.

You may also access a recording of the event here.

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The Alliance Claims and Customer Service Year in Review: 2010

A reflection & review of our claims and customer service performance for 2010

Claims Repricing
Our contracts require that we reprice claims we receive from providers and send them on to the claims administrator within three business days. In 2010, we did this in 0.00 days for electronic claims and 1.76 days for paper claims on average, for an average turnaround of 0.33 days for all claims.

The majority of our claims are filed electronically through our electronic data interchange (EDI):

• 81.2 percent of claims were filed to us from providers electronically.
• 84.8 percent of repriced claims were forwarded to third-party administrators (TPA) electronically.

Call Volumes
Our customer service team experienced a decrease in the number of telephone inquiries in 2010 from 2009. Calls from providers represent 68.84 percent of all the calls received by our customer service staff in 2010, with enrollees at 27.66 percent. TPAs, employers and others made up the rest.

Four of the top five inquiries from all sources continue to be items that are best addressed by TPAs, not The Alliance, representing more than 76 percent of the calls directed to our Customer Service department. These include initial claims status, questions about benefits, eligibility verification, and pre-authorization of services, which are then forwarded on to the TPA.

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Wisconsin’s Locally Owned Farms Can Help Employees Eat Healthy

Community supported agriculture (CSA) is an arrangement between local farms and households. Households pay a fee to the farm, which entitles them to a "share" of the farm's harvest. Each week, or sometimes every other week, the individual then picks up a box of fresh foods from the farm. Many farms also offer individuals a chance to visit the farm and work off a portion of their share by picking or packing boxes.

CSA shares have caught on in the past few years, and are helpful to farms and to individuals who have access to fresh, healthy foods. The Madison Area CSA Coalition (MACSAC), which consists of 42 farms throughout Wisconsin, is eager to help employers provide their employees with more information about this unique arrangement.

Sharing information about CSAs is a great first step to helping them eat healthier this summer and fall. Employers may also want to offer an incentive to their employees to participate in a CSA by offering to pay part of their CSA share. Even a small amount, such as $25 can help.

Many farms fill up early, so the time to promote CSAs is now.

You can find more information about MACSAC on their website including a list of participating farms.

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Healthy Resolution!

From Health Solutions, Ltd.^®

Every year millions of Americans set a New Year’s resolution. Many decide to lose weight, quit smoking or start exercising. However, most give up on their resolution before February. A resolution, like a goal, is a commitment that a person makes to oneself. Employers have a unique opportunity through wellness programming to help their employees not only set attainable resolutions, but provide them with ongoing support and motivation to continue those resolutions year-round.

Employers can encourage employees to take small steps instead of taking giant leaps with their goal-setting. Also, they can think about positive ways to promote these goals as an organization and provide opportunities for change through walking programs, weight loss competitions, or smoking cessation support groups.

Some individuals may have had a resolution that didn’t work out in January, but there’s no reason an organization can’t start with February resolutions. Others, who didn’t have any resolutions in mind, might like the idea of making a healthy resolution now. Some individuals will need guidance in setting goals.

One important way to set goals is to make sure they are meaningful to the person setting them. Individuals need their own motivation along with a supportive environment. Organizations can also set resolutions for the coming year to promote healthier lifestyles for their employees. Health education, initiatives and challenges can help spark a change in employees that they may not have thought about before!

For more information about Health Solutions^®, or about their partnership with The Alliance, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.

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Wellness in the Workplace Conference

The 30th Wellness in the Workplace conference is scheduled for March 9 - 10, 2011, in Ann Arbor, Mich. The conference is sponsored by the University of Michigan Health Management Research Center, which is directed by Dee W. Edington, featured at our 2010 Annual Seminar.

You can learn more at the conference website.

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Welcome Cassie Bueno, Web and Design Specialist

Cassie Bueno has joined The Alliance as Web and design specialist in our marketing and member services department. She brings Web development, design, marketing, public relations, and writing experience. In her role, Cassie will be responsible for the design and content of The Alliance website, analyzing and reporting usage statistics, and developing strategies to increase page views and visitors. She will also manage the format, design, and distribution of electronic and print materials for The Alliance, including the design of this newsletter.

Please join us in welcoming Cassie Bueno, 800.223.4139 x 6634.

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Building Our Cooperative

Please join us in welcoming the following members. All joined The Alliance in January 2011.

Blackhawk Bank
Blackhawk Bank, located in Beloit, Wis., was founded in 1881 and is formerly known as Beloit Savings Bank. According to Bauer Financial, one of the nation’s most recognized financial institution ratings services, Blackhawk Bank is one of the highest-rated community banks in the region.

Clifton Gunderson
Clifton Gunderson was founded in 1960 and is one of the nation’s largest certified public accounting and consulting firms. The firm has 46 offices located throughout the U.S. and employs more than 1,900 professionals. The firm provides personal and high-quality service to clients in over 100 countries.

Gypsum Supply Co.
Gypsum Supply Co. is located in numerous cities throughout Wisconsin, Iowa, and Illinois and is the premier supplier of drywall, plaster, insulation, tile and grid, steel framing, stone veneer, and tools and accessories. Their mission is to serve customers with quality products and quality service at a fair price.

The Insurance Center
The Insurance Center (T.I.C., Inc.) was founded in the 1960s in La Crosse, Wis., and strives to provide quality and affordable health insurance to dairy farmers in Southwest Wisconsin. T.I.C., Inc. serves thousands of clients and is one of the largest independent insurance and financial service agencies in the Midwest.

Lime Rock Springs Co.
Lime Rock Springs Co. was founded in 1917 and is located in Dubuque, Iowa. The company bottled a full line of flavored soft drinks under its own label until 1936, when it began bottling and distributing Pepsi-Cola brands. The company now procures its products from Wis. Pak, Inc., a multi-plant cooperative servicing the company and more than 30 other independent Pepsi-Cola bottlers in the Midwest.

Progressive Processing
Progressive Processing, a wholly-owned subsidiary of Hormel foods, was the first food processing plant built by Hormel in 25 years. The plant was built to meet demands to produce one of Hormel’s most successful products, Compleats, a shelf-stable brand of microwaveable meals. The facility is located in Dubuque, Iowa.

Reedsburg Area Medical Center
Reedsburg Area Medical Center (RAMC) is an independent, non-profit organization that has been serving the people of Reedsburg since 1902. It serves more than 23,000 people in Reedsburg, Wis., and surrounding areas, and employs more than 430 people. RAMC is a combination facility consisting of the Reedsburg Area Specialty Center & Surgery Center, Reedsburg Area Senior Life Center, and the RAMC Urgent Care Center.

SECURA Insurance Company, Inc.
SECURA Insurance Company, Inc. originated in 1900 after a natural disaster tore through New Richmond, Wis. and 135 charter members developed the Farmer’s Home Mutual Hail, Tornado, and Cyclone Insurance Company. The organization was renamed SECURA Insurance in 1986 and is now located in Appleton, Wis. SECURA Insurance has grown from a small farm company into a regional carrier, offering policyholders everything they need to feel secure at home, work, play, and in between.

Trachte Building Systems, Inc.
Trachte Building Systems, Inc. is an employee-owned organization with more than 100 years of experience in manufacturing steel, self-storage systems. Trachte is located in Sun Prairie, Wis., and is one of the largest manufacturers of steel self-storage systems in the industry and has mastered the art of developing smart building products customized to their clients’ needs.

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Alliance Provider Update

The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.

Just a reminder: Always check the online provider directory for the most current provider information!

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QualityCounts™ for Employees

The Alliance encourages employers to distribute the monthly QualityCounts™ for Employees informational piece to their employees.

We’ll be releasing the next QualityCounts™ Inpatient Hospital Report in the next month. This piece (.pdf) can help employers make sure employees know about it and how to access it.

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News You Can Use

Each month, The Alliance highlights health care and benefit management news for employers in News You Can Use, with a link to take you to the original story or report.

LaFarge Sees Reduction in Medical Cost Trend with Wellness Program
Read how Lafarge, the largest diversified supplier of construction materials in the U.S. and Canada, updated its health and productivity program and saw reduction in medical cost trend and improved health of its employees. Read more.

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About The Alliance Agent and Consultant Briefing

Each month, The Alliance Agent and Consultant Briefing delivers the latest news to insurance agents and consultants about Alliance services, programs and events, as well as information on health benefit trends, issues and ideas of interest to our mutual clients.

Subscriptions are available on a complimentary basis. To subscribe, please send an e-mail with your name, title and organization to the marketing and member services department.

Reader comments, suggestions and topics are always welcome.

Cathy Lanser, Editor
Cassie Bueno, Design
Diane Loram, Business Development Manager

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