Providing High-Value Healthcare to Self-Funded Employers
We bridge the gap between providers and employers, partnering with you to bring high-quality, fairly priced services to employers, employees, and their families.
Our strong employer connections and employee guidance initiatives can benefit your practice (or hospital or health system) while helping you care for your local community.
To date, we’ve partnered with 39,000 doctors and healthcare providers across the Midwest, offering coverage to more than 118,000 people.
Four Core Drivers for High-Value Healthcare
The Alliance® works with employers using our four core drivers to effectively change healthcare. We believe that initiatives like pushing for price transparency and rewarding value (rather than volume) of services will move the market to a more favorable position for employers.
Provider Network Design
The Alliance contracts directly with providers on our employer’s behalf to ensure convenient access to care for employees while encouraging competition on price and quality. Our provider networks are continually expanding based on the needs of current and prospective cooperative employers, giving employees more high-value healthcare options.
Payment Reform
The way healthcare is paid for influences the behavior of doctors and hospitals, which is why we continue to expand our Reference-Based Contracting initiative. Fee-for-service isn’t working for employers or patients, which is why we need to redefine their payment methodology to reward cost effective, high-quality care rather than volume of services.The Alliance will also continue to provide programs like bundled payment services to further our payment reform efforts.
Benefit Plan Design
Employers can add incentives to their benefits plan, encouraging employee use of certain doctors and hospitals – not to limit employee choice but to choose those that deliver the best care at the lowest cost. And when enough employers get involved and provide these kind of incentives, physicians are motivated to improve the value of their care.
Transparency
You can’t manage what you can’t measure. The Alliance is working to provide accurate, easy-to-access information comparing cost and quality from different providers so high-value healthcare can be chosen that deliver good results at lower prices.
The Alliance also actively participates as a leader in public health policy by influencing legislation through education, and encouraging hospital price transparency initiatives.
Healthcare Transparency for Employers
Transparency isn’t just our first core driver of High-Value Healthcare; it’s at the heart of who we are and what we do. The Alliance understands that in order to influence change in healthcare, we need a goal to strive towards and a benchmark to measure against.
RAND Corporation
In our continuance of real dedication to transparency, The Alliance and its employer-members participated in RAND Corporation’s Hospital Pricing Transparency Project (Rand 3.0 and 4.0)– a nationwide analysis of commercial inpatient and outpatient hospital prices paid by private insurers and employers vs. Medicare prices. The study provides a much-needed measuring stick that employers can use to leverage better rates and better quality with hospital systems.
Wisconsin Statewide Health Information Network (WISHIN)
The Alliance partners with the Wisconsin Statewide Health Information Network (WISHIN), an independent not-for-profit organization dedicated to bringing the benefits of widespread, secure, interoperable health information technology to patients and caregivers by building a statewide health information network to connect physicians, clinics, hospitals, pharmacies, and clinical laboratories.
Wisconsin Health Information Organization (WHIO)
Cheryl DeMars, CEO of The Alliance, is a Board Member for the Wisconsin Health Information Organization (WHIO). WHIO is a nonprofit organization that aims to improve the quality, affordability, safety, and efficiency of healthcare in Wisconsin. They drive this goal with their All-Payer Claims Database (APCD) – the single largest source of healthcare data and information in Wisconsin.
Wisconsin Collaborative for Healthcare Quality (WHCQ)
The Alliance is a proud partner of the Wisconsin Collaborative for Healthcare Quality (WHCQ), which publicly reports and brings meaning to performance measurement information that improves the quality and affordability of healthcare in Wisconsin. WCHQ’s members represent more than 65% of Wisconsin’s primary care physicians.
National Quality Forum
The Alliance is a proud member of the National Quality Forum, a non-profit organization that measures and standardizes critically important initiatives to enhance healthcare value, make patient care safer, and achieve better outcomes.
The National Alliance of Healthcare Purchaser Coalitions
The Alliance is a proud member of The National Alliance of Healthcare Purchaser Coalitions, a nonprofit, purchaser-led organization dedicated to driving health and healthcare value across the country.
The Leapfrog Group
The Leapfrog Group is a national non-profit organization based in Washington, D.C. that uses the shared leverage of large healthcare purchasers to initiate improvements in safety, quality, and affordability of healthcare for Americans. The Leapfrog Hospital Safety Grade rates hospitals on how well they protect their patients from errors, injuries, accidents and infections, which harm millions of patients every year. This grading system has become a widely-accepted measure of patient safety and includes 30 measures, all currently in use by national measurement and reporting programs.
“You Can’t Manage What You Can’t Measure”
As our former CEO, Cheryl DeMars, likes to put it, “You can’t manage what you can’t measure,” which is why the disclosure of cost and quality information is central to the mission of The Alliance. These measurements have come a long way, but gaps remain between the information we need and what is available today. In an ideal world, healthcare buyers would have a single online marketplace to compare meaningful cost and quality information from provider to provider and hospital to hospital.
Although healthcare does not quite work that way, The Alliance strives towards providing accurate, easy-to-access information that employer groups can use to compare and contrast both cost and quality. This allows consumers to make more informed decisions about their health while saving money.
Transparency is also about measuring provider performance so we can get to a healthcare payment model that emphasizes the value of care instead of volume. But we can’t reward providers for value unless employers – the single largest healthcare purchasers in the country – become more active healthcare shoppers.
Ultimately, by joining a coalition and combining their purchasing power to disrupt how healthcare is purchased, employers can force policy changes that are more favorable for the consumer –
- Public reporting of standard charges and negotiated rates for common, shoppable procedures. The rates negotiated between insurance companies and doctors and hospitals are considered proprietary information by the industry, but this keeps the public in the dark about price differences.
- Using public purchasing programs to provide a benchmark to measure cost and quality. The power of public purchasing programs like Medicare and Medicaid can help align and improve public reporting of healthcare quality measures.
- Increasing access to data. Greater access to data will help researchers, entrepreneurs, and providers identify ways to improve care while lowering costs.
- Addressing surprise medical bills. By providing protection for patients who face out-of-network charges in emergency situations.