August 8, 2014
Volume 57, Issue 32


Wisconsin Medicaid’s Hidden Health Care Tax Increasing the Cost of Health Care
Medicaid reimbursement and coverage expansion among topics discussed at recent meeting of the WHA Public Policy Council

During the August 7 meeting of WHA’s Public Policy Council, WHA Executive Vice President Eric Borgerding; Kyle O’Brien, vice president of government relations; and Jenny Boese, vice president of external relations and member advocacy, informed the Council about WHA’s efforts to improve Medicaid reimbursement and cut the hidden health care tax.

"Wisconsin’s Medicaid reimbursement falls significantly below other states nationally," said Borgerding. "This under-reimbursement leads to cost-shifting and higher health care costs for Wisconsin employers and patients."

To combat the "hidden health care tax," WHA will continue the advocacy drumbeat to raise Wisconsin’s low Medicaid reimbursements. For the foreseeable future, WHA will employ a multi-pronged effort to educate legislators and candidates about the issue and the need to increase reimbursement rates. WHA will facilitate face-to-face meetings, roundtable discussions, educational webinars and other tactics.

"The legislative ‘off season’ is the time during which we tee up the next legislative cycle," Borgerding said. "Our job of advocacy is never done."

Joanne Alig, WHA senior vice president, policy and research, provided the Council with information about Medicaid enrollment, including the recent information released by DHS concerning statewide individual enrollment.

Alig explained that while DHS’s original biennial budget projection estimated there would be an overall reduction in Medicaid enrollment after the recent changes to Wisconsin’s Medicaid program were implemented, the state has seen an overall increase in Medicaid enrollment of close to 25,000 people compared to June 2013. In addition, DHS originally anticipated that 107,000 newly-eligible childless adults would be enrolled by January 2015, whereas the most recent projection is for 135,000.

WHA continues to evaluate the overall effects of the coverage changes in Wisconsin, according to Alig. Currently available data does not provide a complete picture of the changes—for example, estimates as to overall reductions of the uninsured population vary widely, according to national studies.

Alig drew the Council’s attention to the continued uncertainty surrounding exchange coverage, particularly with the recent court cases that throw into question whether federal tax subsidies will continue to be available under the ACA to individuals enrolled in a health insurance exchange that is operated by the federal government as opposed to a state government. Alig further explained, however, there is little immediate effect of these court cases because of the lengthy appeals process.

Hospitals and health systems are already thinking about the next open enrollment period for the 2015 benefit year for the Wisconsin health insurance exchange, which begins November 15, according to Alig.

Jodi Johnson, WHA vice president of workforce and clinical practice, told the Council the Wisconsin Board of Nursing is in the process of revising the administrative rule that governs advanced practice nurse prescribers (APNPs). According to Johnson, the Wisconsin Nurses Association has proposed revising the rule to eliminate the requirement for APNPs to have a documented collaborative agreement with physicians related to the delivery of health care services.

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Assistant Assembly Majority Leader Touts WHA’s Advocacy Efforts
Steineke discusses issues impacting hospitals, including Medicaid and Worker’s Compensation

Rep. Jim Steineke (R-Kaukauna), the Assembly Assistant Majority Leader, spoke to WHA’s Public Policy Council at their August 7 meeting and briefed the Council on what to expect from the Assembly Republican caucus during the next legislative session.

"We will push forward on reforms as we have the past four years," said Steineke. "We’ll continue with fiscal reforms, and I envision an aggressive tax reform package."

Steineke, who was a member of the Speaker’s Task Force on Mental Health and the Assembly Health Committee, discussed the results of the Speaker’s Task Force.

"We were able to bring everyone together and make significant changes," said Steineke.

He credited statewide hearings and stakeholder input in making the Task Force’s recommendations a success. The Speaker’s Task Force recommendations included a proposal from WHA’s Behavioral Health Task Force that aligned Wisconsin’s mental health records law with HIPAA. This legislation was recommended by the Task Force, introduced by a bipartisan group of lawmakers in the Senate and Assembly, and signed into law in April 2014 by Governor Scott Walker.

Steineke credited WHA’s advocacy efforts with stopping legislation to impose a government fee schedule in Wisconsin’s Worker’s Compensation program. Steineke said that his caucus "understands that we’re not content experts on every subject of possible legislation, and we try to listen to actual industry experts to best understand the nuances and complexities of issues." With respect to health care, Steineke said that he "appreciate[s] WHA’s input and feedback when health care issues arise. When you speak, we listen."

Mark Hamilton, vice president of ambulatory operations at UW Health, asked Steineke about hospital reimbursement in the Medicaid program. Hamilton said the WHA Council on Public Policy had just finished a lengthy conversation about poor reimbursement in Wisconsin’s Medicaid program for hospitals services. The Medicaid program covers only 65 percent of the cost of providing hospital services, resulting in a reimbursement rate that is 27 percent below the national average and cost-shifts $850 million a year in health care costs to Wisconsin’s employers.

Steineke credited WHA for making members of his caucus aware of the Wisconsin Medicaid reimbursement issue.

"I’m not sure if people understand how Medicaid reimbursement rates affect the entire industry," said Steineke, referring to cost-shifting that results in a hidden health care tax on Wisconsin employers.

"We haven’t had a broad policy conversation on this, but it’s something the caucus will be aware of as we move into the next session," said Steineke.

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Political Action Fundraising Campaign Update – 67% of Goal

The 2014 Wisconsin Hospitals Conduit and State PAC Fundraising Campaign has raised over $16,000 more in contributions in the last two weeks, putting the year-to-date total at $176,759. This puts the campaign at 67 percent of the goal to raise $265,000 by the end of the year.

In the last two weeks, the campaign added 12 more individuals including two additional Platinum Club members. Those additional 12 individuals are listed on page 6 alphabetically by contribution amount category along with all of the 2014 contributors to date. Thank you!

The next publication of the contributor list will be in the August 22 edition of The Valued Voice.

For more information, contact Jodi Bloch at 608-217-9508 or Jenny Boese at 608-274-1820.

Contributors ranging from $1 to $499
Alstad, Nancy Fort HealthCare
Anderson, Phil Sacred Heart Hospital
Anich, Matthew Memorial Medical Center - Ashland
Appleby, Jane Aurora Health Care
Bagnall, Andrew St. Nicholas Hospital
Bair, Barbara St. Clare Hospital & Health Services
Bayer, Tom St. Vincent Hospital
Brenholt, Craig St. Joseph's Hospital
Brenny, Terrence Stoughton Hospital Association
Buser, Kenneth Wheaton Franciscan Healthcare - All Saints
Cardinal, Lori Agnesian HealthCare
Carlson, Peter Aurora Psychiatric Hospital
Ceelen, John Ministry Health Care
Censky, Bill Holy Family Memorial
Clark, Julie St. Joseph's Hospital
Clark, Renee Fort HealthCare
Collins, Sherry Wisconsin Hospital Association
Coopman, Dianne St. Mary's Janesville Hospital
Cormier, Laura Bellin Hospital
Dalebroux, Steve St. Mary's Hospital
Donlon, Marcia Holy Family Memorial
Duda, Carrie Wheaton Franciscan Healthcare - All Saints
Dux, Larry Froedtert & MCW Community Memorial Hospital campus
Dwyer, Maxine St. Mary's Hospital
Ferrigno, Sandra St. Mary's Hospital
Fielding, Laura Holy Family Memorial
Furlong, Marian Hudson Hospital & Clinics
Gormican, John J. Agnesian HealthCare
Graul, Mark Children's Hospital of Wisconsin
Groskreutz, Kevin St. Joseph's Hospital
Gullicksrud, Lynn Sacred Heart Hospital
Gustafson, Andy SSM Health Care-Wisconsin
Hafeman, Paula St. Vincent Hospital
Halida, Cheryl St. Joseph's Hospital
Hamilton, Mark
Harrington, Kathleen Mayo Health System - Eau Claire
Heaney, Dwight Fort HealthCare
Henricks, William Rogers Memorial Hospital
Hieb, Laura Bellin Hospital
Hill, Juliet Sacred Heart Hospital
Holub, Gregory Ministry Door County Medical Center
Jelle, Laura St. Clare Hospital & Health Services
Karow, Deborah Ministry Health Care's Howard Young Medical Center
Kaufmann, Marilyn Holy Family Memorial
King, Steve St. Mary's Hospital
Kingston, Mary Beth Aurora Health Care
Klay, Chris St. Joseph's Hospital
Klay, Lois St. Joseph's Hospital
Koch, Mark Mayo Clinic Health System
Koebke, Troy Bellin Hospital
Kuehni-Flanagan, Tracy St. Joseph's Hospital
Lambrecht, Randy Aurora Health Care
Larson, William St. Joseph's Hospital
Leonard, Mary Kay St. Mary's Hospital
Luehring, Sally St. Vincent Hospital
Lynch, Sue Mayo Health System - Franciscan Healthcare
Marquardt, Amy Hospital Sisters Health System
Maurer, Mary Holy Family Memorial
Mays, Laura Stoughton Hospital Association
McMeans, Scott Holy Family Memorial
Meicher, John St. Mary's Hospital
Mercer, Carla Reedsburg Area Medical Center
Mohr, Carol Sacred Heart Hospital
Neikirk, Jon Froedtert & The Medical College of Wisconsin
Newberry-Ferguson, Linda ProHealth Care - Rehabilitation Hospital of WI
O'Brien, Laura
Ott, Virginia St. Joseph's Hospital
Palecek, Steve St. Joseph's Hospital
Peiffer, Susan Sacred Heart Hospital
Penovich, Carrie Aurora Medical Center in Two Rivers
Riddle, Roberta Rusk County Memorial Hospital
Roundy, Ann Columbus Community Hospital
Schweitzer, Susan Columbus Community Hospital
Selle, Ginger St. Clare Hospital & Health Services
Shear, Jim  
Sommers, Craig St. Mary's Hospital
Sparacino, Gloria Aurora West Allis Medical Center
Steines, Sara Children's Hospital of Wisconsin
Stephens, Brian Ministry Door County Medical Center
Stranberg, Kevin Memorial Medical Center - Ashland
Sullivan, Anne Memorial Medical Center - Ashland
Teigen, Seth St. Mary's Hospital
Theiler, Brian Gundersen Tri-County Hospital and Clinics
Turtenwald, Robyn Froedtert & MCW Community Memorial Hospital campus
Van Meeteren, Bob Reedsburg Area Medical Center
Washburn, Juliane Bay Area Medical Center
Werkheiser, Cindy Monroe Clinic
Westbrook, Diane River Falls Area Hospital
Wheeler, Susan St. Nicholas Hospital
Woleske, Chris Bellin Hospital
Wymelenberg, Tracy Aurora Health Care
Ziebarth, Laura St. Mary's Hospital
Contributors ranging from $500 to $999
Brenton, Andrew Wisconsin Hospital Association
Carlson, Dan Bay Area Medical Center
Connors, Lawrence St. Mary's Hospital Medical Center
Dexter, Donn Mayo Health System - Eau Claire
Dietsche, James Bellin Hospital
Dolohanty, Naomi Aurora Health Care
Eckels, Timothy Hospital Sisters Health System
Freimund, Rooney Bay Area Medical Center
Granger, Lorna Aurora Health Care
Gullingsrud, Tim Hayward Area Memorial Hospital and Nursing Home
Huettl, Patricia Holy Family Memorial
Jacobson, Terry St. Mary's Hospital of Superior
Jensema, Christine HSHS-Eastern Wisconsin Division
Kersten, Juliet Children's Hospital of Wisconsin
Kerwin, Kathleen  
Kocourek, Cathie Aurora Medical Center in Two Rivers
Larson, Margaret Mercy Medical Center
Malone, Virginia St. Mary's Hospital
Mantei, Mary Jo Bay Area Medical Center
Mulder, Doris Beloit Health System
Nelson, James Fort HealthCare
Nesse, Robert Mayo Clinic Health System
O'Keefe, James Mile Bluff Medical Center
Oland, Charisse Rusk County Memorial Hospital
Ordinans, Karen Children's Hospital of Wisconsin
Ose, Peggy Riverview Hospital Association
Peterson, Douglas Chippewa Valley Hospital
Quinn, George Wisconsin Hospital Association
Rohrbach, Dan Southwest Health Center
Rutkowski, Jennifer Grant Regional Health Center
Selberg, Heidi HSHS-Eastern Wisconsin Division
Shabino, Charles Wisconsin Hospital Association
Sprecher, Lon  
Stuart, Philip Tomah Memorial Hospital
VanCourt, Bernie Bay Area Medical Center
White-Jacobs, Mary Beth Black River Memorial Hospital
Contributors ranging from $1,000 to $1,499
Ashenhurst, Karla Ministry Health Care
Bablitch, Steve Aurora Health Care
Bedwell, Elizabeth Children's Hospital of Wisconsin
Garcia-Thomas, Cristy Aurora Health Care
Geraghty, Tricia Children's Hospital of Wisconsin
Gorelick, Marc Children's Hospital of Wisconsin
Gunn, Veronica Children's Hospital of Wisconsin
Hart, Shelly Aurora Health Care
Hayden, Kevin  
Janis, Gerald Aurora Health Care
Just, Lisa Aurora Health Care
Kosanovich, John Watertown Regional Medical Center
Kostroski, Sharon Ministry Saint Joseph's Hospital
Lewis, Jonathan St. Mary's Hospital
Loftus, Philip Aurora Health Care
Martin, Jeff Ministry Saint Michael's Hospital
McDonald, Mary Beth Aurora Health Care
McKevett, Timothy Beloit Health System
Mohorek, Ronald Ministry Health Care
Natzke, Ryan Marshfield Clinic
Nauman, Michael Children's Hospital of Wisconsin
Nelson, Dave HSHS-Western Wisconsin Division
Norbin Killoran, Carrie Aurora Health Care
Potts, Dennis Aurora Health Care
Rakowski, Mark Children's Hospital of Wisconsin
Rickelman, Debbie WHA Information Center
Rislov, Amy Aurora Health Care
Russell, John Columbus Community Hospital
Sanders, Robert Children's Hospital of Wisconsin
Schafer, Michael Spooner Health System
Schmidt, Cheryl St. Elizabeth Hospital
Shanahan, Thomas Children's Hospital of Wisconsin
Stamas, Peter Ministry Saint Joseph's Hospital
Contributors ranging from $1,500 to $1,999
Anderson, Layton Ministry Saint Joseph's Hospital
Anderson, Sandy St. Clare Hospital & Health Services
Bloch, Jodi Wisconsin Hospital Association
Boatwright, Damond SSM Health Care-Wisconsin
Boese, Jennifer Wisconsin Hospital Association
Boland, Susan Wheaton Franciscan Healthcare - All Saints
Byrne, Frank St. Mary's Hospital
Clapp, Nicole Grant Regional Health Center
Coffman, Joan St. Joseph's Hospital
Court, Kelly Wisconsin Hospital Association
Duncan, Robert Children's Hospital of Wisconsin
Falvey, Patrick Aurora Health Care
Francis, Jeff Ministry Health Care
Frank, Jennifer Wisconsin Hospital Association
Grasmick, Mary Kay Wisconsin Hospital Association
Harding, Edward Bay Area Medical Center
Herzog, Mark Holy Family Memorial
Hilt, Monica Ministry Saint Mary's Hospital
Johnson, Jodi Wisconsin Hospital Association
Lewis, Gordon Burnett Medical Center
Meyer, Daniel Aurora BayCare Medical Center in Green Bay
Roller, Rachel Aurora Health Care
Sexton, William Prairie du Chien Memorial Hospital
Sheehan, John
Stanford, Matthew Wisconsin Hospital Association
Wallace, Michael Fort HealthCare
Contributors ranging from $2,000 to $2,999
Alig, Joanne Wisconsin Hospital Association
Brenton, Mary E.
Brooks, Alenia Aurora Health Care
Brophy, Michael Aurora Health Care
Colman, Gerard Aurora Health Care
Gage, Weldon Children's Hospital of Wisconsin
Hanson, Gail Aurora Health Care
Kachelski, Joe Wisconsin Statewide Health Information Network
Kelch, Elaine
Kief, Brian Ministry Saint Joseph's Hospital
Leitch, Laura Hall Render Killian Heath & Lyman
Levin, Jeremy Rural Wisconsin Health Cooperative
Normington, Jeremy Moundview Memorial Hospital & Clinics
O'Brien, Kyle Wisconsin Hospital Association
Pandl, Therese HSHS-Eastern Wisconsin Division
Potter, Brian Wisconsin Hospital Association
Sanders, Michael Monroe Clinic
Standridge, Debra Wheaton Franciscan Healthcare
Starmann-Harrison, Mary Hospital Sisters Health System
Troy, Peggy Children's Hospital of Wisconsin
Contributors ranging from $3,000 to $4,999
Jacobson, Catherine Froedtert & The Medical College of Wisconsin
Katen-Bahensky, Donna
Kerwin, George Bellin Hospital
Little, Steve Agnesian HealthCare, Inc
Mettner, Michelle Children's Hospital of Wisconsin
Neufelder, Daniel Ministry Health Care
Turkal, Nick Aurora Health Care
Contributors $5,000 and above
Borgerding, Eric Wisconsin Hospital Association
Brenton, Stephen Wisconsin Hospital Association
Size, Tim Rural Wisconsin Health Cooperative
Tyre, Scott Capitol Navigators, Inc


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Wisconsin Hospital Leaders Meet with CMS
Dialogue requested by Reps. Kind, Ribble and rural hospitals

Eight Wisconsin leaders traveled to Washington, DC the week of August 4 to meet with top officials in the Centers for Medicare and Medicaid Services (CMS) regarding rural hospital issues. The meeting was requested by U.S. Congressman Ron Kind (D-La Crosse) and U.S. Representative Reid Ribble (R-Green Bay) on behalf of Wisconsin’s rural hospitals due to ongoing federal proposals that negatively impact rural health care.

"We are writing to express our deep concerns with recent events," the Kind-Ribble letter read. "Whether it was the Office of Inspector General’s most recent report on critical access hospitals (CAHs) or recent CMS regulations that will undermine the rural health care safety-net, we are concerned by what these policies will mean for the health care needs of our constituents and millions of rural residents across the country."

Four Wisconsin rural hospital CEOs and leaders from the Wisconsin Hospital Association and Rural Wisconsin Health Cooperative met with CMS officials August 4 in Washington, DC. Key CMS participants included CMS Deputy Administrator Sean Cavanaugh, and Marc Hartstein, CMS director of hospital & ambulatory policy group, as well as individuals from the offices of Reps. Kind and Ribble.

Hospital leaders opened the discussion by thanking CMS for the meeting and expressing the desire to work collaboratively on rural policies in the future.

"We appreciate the spirit with which you opened this meeting," said CMS Deputy Administrator Sean Cavanaugh. "And we want to work with you."

The leaders provided insight into how Wisconsin’s rural hospitals—both CAHs and rural "tweeners"—have demonstrated the commitment to quality and cost efficiency just like their peers at larger facilities. Further, this commitment translates into significant value to the Medicare program, which is then undermined by certain proposals and policies coming out of DC. Policies discussed included proposed changes to the CAH program, rural graduate medical education, direct supervision requirements and the 96-hour rule.

The overall goal of the meeting was to initiate an ongoing discussion with CMS and allow rural hospitals the ability to provide on-the-ground insight into what policy proposals in DC mean back home in rural America. To that end, one outcome already has been CMS Deputy Director Sean Cavanaugh agreeability to the group’s invitation to travel to Wisconsin to visit with high-value rural health care providers. Additional follow-up is also underway.

Wisconsin hospital leaders participating in the meeting included:

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Webinar on WHA Patient Discharge & Transfer Manual

WHA will continue its months-long complimentary webinar series August 14 from 12-1:30 p.m. with a presentation of the WHA Patient Discharge & Transfer Manual. This webinar will address the legal issues related to the discharge or transfer of a patient. The presenters will discuss medically-indicated discharge and transfer, as well as certain factors that can complicate the discharge or transfer of a patient and heighten a health care organization’s potential liability exposure.

WHA members are encouraged to register for this webinar as well as any or all of the other webinars in the series. Sign-up information, as well as more information about each of the remaining webinars in the series, may be found at http://events.SignUp4.net/HealthLawManual. Attorneys in attendance may earn CLE credit.

This webinar will be presented by Jennifer Hennessy and Leah McNeely of the law firm of Quarles & Brady.

The Health Law Manuals are available for WHA members to view and download at www.wha.org/healthLawManual.aspx. WHA members who would like to view the manuals should contact webmaster@wha.org to request a username and password.

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WHA Publishes Health Care Terminology Guide

The Wisconsin Hospital Association (WHA) has prepared a web-based guide entitled Health Care Acronyms and Terminology to help provide a basic understanding of various acronyms and terms used in health care. The guide contains definitions that apply to topics related to reimbursement, health reform, medicine, quality and workforce. It will be helpful to a variety of audiences, including hospital and health system employees, physicians and trustees.

The guide has been posted on www.wha.org in the Members Only section, under the "General" tab. If you are employed by a WHA member and have not registered for access to the Members Only section, go to http://members.wha.org.

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ICD-10 Compliance Date of October 1, 2015 Now Official

The U.S. Department of Health and Human Services (HHS) issued a final rule on July 31, 2014 finalizing October 1, 2015 as the new compliance date for health care providers, health plans and health care clearinghouses to transition to ICD-10. HHS released the final rule in the Federal Register August 4.

Congress passed H.R. 4302, "Protecting Access to Medicare Act of 2014" in March, which stated that ICD-10 implementation would not occur prior to October 1, 2015.

The 2014 IPPS proposed rule indicated that ICD-10 implementation would be pushed out exactly one year, but one day later CMS appeared to backtrack when it issued the following statement: On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

After months of not knowing as to whether the new code set would be implemented next year, the wait is finally over. The final rule states that the one-year delay will allow health care providers to reap the benefits of ICD-10 as soon as possible and is also the least expensive option.

Although HHS originally planned to release an interim final rule with the new compliance date, it sent a final rule to the Office of Management and Budget for review June 13. A final rule does not allow comments. HHS is permitted to waive rulemaking requirements if it finds that notice and comment procedures are impractical, unnecessary, or contrary to the public interest. HHS believes "waiving normal notice and comment rulemaking requirements is justified because covered entities need to know how to proceed with respect to ICD-9-CM and ICD-10 now, or they will not have adequate time to prepare to accurately submit, process and pay for health care claims."

"Wisconsin stakeholders are moving forward," said Debbie Rickelman, vice president, WHA Information Center. "The Wisconsin ICD-10 Collaborative reconvenes next week to share implementation strategies across the industry, and the ICD-10 topic is high on the priority list of several other Wisconsin-based organizations such as the Wisconsin Health Information Management Association, HIPAA Collaborative of Wisconsin, Wisconsin Medical Society, and the Rural Wisconsin Health Cooperative."

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Six Wisconsin Health Care Systems Form New Statewide Network

Six Wisconsin health care organizations are pioneering a statewide network to provide patients access to the highest quality health care across the state and region. The organizations expect the network to serve as a new model for the nation.

The partnership’s founding members include:

Together, the organizations’ service areas provide access to health care for about 90 percent of Wisconsin’s population. They also serve people in neighboring Illinois, Iowa, Michigan and Minnesota. Each organization in the partnership uses the same technology for electronic medical records, making it easier for patients to access their records and share with doctors in the network.

"Our vision is to use our collective resources wisely by being good stewards of the clinical, administrative, IT, research, patient experience, care management and other shared expertise within our six systems," said Greg Devine, president and CEO of the partnership. "We want to provide better value in health care."

An initial commercial insurance plan featuring the six organizations is being offered through Anthem Blue Cross Blue Shield’s Blue Priority network.

The partnership plans to expand coverage options and is evaluating other insurance carriers and administrative products. "Employers and government purchasers now have access to the economic and clinical benefits of a more efficient, high-quality network of care for their employees and families across the state," said Devine. "Our aim is that the partnership will be featured in insurance plans that serve the needs of individual purchasers, as well as national employers that have a statewide presence or that are headquartered in areas we serve."

Jeff Thompson, MD, chair of the partnership’s board of directors and CEO of La Crosse-based Gundersen Health System, said, "This is a true partnership among our six organizations, not a merger or consolidation. It will allow us to more rapidly learn from each other, share best practices, and serve the needs of patients and families more efficiently."

The partnership is open to expanding its membership to include other health organizations that have a demonstrated record of delivering quality, value-based care.

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