December 2, 2016
Volume 60, Issue 48

GIB Discusses Pros/Cons of Self Funding State Employee Health Care Program
Approves vendor for data warehouse

On November 30, the state Department of Employee Trust Funds (ETF) shared its perspectives on the current State Group Health Insurance Program and the advantages and disadvantages of moving to a self-funded model. The report was given in advance of a near day-long closed-door session during which the Group Insurance Board (GIB) reviewed the nine responses it received to a request for proposals (RFP) for self-funding and considered options for self-funding and regionalization.

No decisions were made by the GIB at the November 30 meeting with regard to self-funding. The GIB instructed ETF staff to develop recommendations for GIB action at their next meeting on December 13.

At issue is whether the state should self fund the state employee group health insurance program, a proposal that the GIB has been considering for several years. The GIB has had two consultants review the program, each with widely differing views of potential savings to the State, with one consultant suggesting the State could save $40 to $50 million and another concluding that self-funding could cost the State up to $100 million.

In a memo released to the GIB this week, ETF staff noted that both consultants determined the State could save about $18 million from avoiding the premium taxes on fully-insured plans that were implemented as part of the Affordable Care Act. These taxes are now called into question, as there has been legislative support to rescind those taxes, which would impact any potential savings.

Highlights of the ETF memo were shared at the November 30 meeting by Lisa Ellinger, director of the Office of Strategic Health Policy for ETF. Ellinger provided a balanced view of self funding, which recognized the strengths of the current system and ETF’s ability to negotiate with health plans to keep the premium trending at a low rate.

However, Ellinger noted that as important as self funding is the consideration of a regional approach to the group health insurance program. Currently, many of the health plans in the state group health program are affiliated with an integrated health care system within a local geographic service area. This ensures the financial incentives for the plan and provider are appropriately aligned to improve quality, efficiency and patient outcomes.

The ETF memo suggests the State could instead establish regions with defined service areas as a way to ease their administrative burden and indicates it would be expected that some health plans would not be able to have a network that covered the entire ETF-defined region. The memo notes, however, that a regional approach could impact premiums. According to the memo, "For decades, the program has leveraged Wisconsin’s uniquely competitive health insurance marketplace to maintain reasonable premium increases and offer choice to our members. If there are fewer qualified health insurers to compete for our member population, it could impact ETF’s ability to negotiate reasonable premium increases."

Ellinger also described recent actions by the GIB that will improve the program regardless of the overall funding structure. Ellinger said the State has continued to have interest in obtaining better and more complete claims data from the health plans participating in the program, and the GIB had approved ETF moving forward with an RFP from a data vendor earlier in 2016. At the November 30 meeting, the GIB selected Truven Health Analytics as the data warehousing vendor, with contract negotiations to be finalized early in 2017.

Within the past week there have also been two articles regarding the risks of self funding in the Madison and Milwaukee newspapers. To view these articles, see and

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Newly-Appointed HHS Sec. Price Visited Wisconsin Hospitals, Clinic

President-elect Donald Trump’s announcement that U.S. Rep. Tom Price (R-Georgia) will be the new Health and Human Services Secretary sent WHA’s staff to the Valued Voice archive. An April 2012 Valued Voice article featured Price’s visit to Wisconsin where he joined U.S. Rep. Reid Ribble and visited leaders from HSHS St. Vincent Hospital and Prevea Health, both in Green Bay, and Door County Medical Center in Sturgeon Bay.

"We were very pleased to welcome Rep. Price to Wisconsin in 2012 when he made a stop in our state to learn more about Wisconsin’s high-quality, high-value health care," according to WHA President/CEO Eric Borgerding. "We look forward to working with him in his new role as HHS Secretary in the coming months as important decisions are made concerning health care policy that will impact hospitals and health systems for many years to come."

See the original Valued Voice article below:

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Congressional Lame-Duck Session, 21st Century Cures Includes Mid-Build HOPD Language
WHA webinar on Section 603/OPPS/Mid-Build scheduled December 8

On November 24, the U.S. House released a 1,000-page bill dubbed the "21st Century Cures" package. While the package includes the 21st Century Cures bill on medical research and innovation, it also includes significant mental health care reform and other stand-alone pieces of legislation.

One of those stand-alone bills merged into this package is the "Helping Hospitals Improve Patient Care Act," HR 5273, which provides some flexibility for certain hospital outpatient department (HOPD) projects caught up in the Section 603 prohibition enacted last year under the Bipartisan Budget Act of 2015 (BBA 2015). WHA has been actively working with Congress to see these mid-build situations exempted from BBA 2015’s Section 603 and is pleased that Congress has included this targeted fix into the 21st Century Cures package.

"The abrupt enactment of Section 603 last November put many long-planned projects in limbo and brought unnecessary disruption to important service changes and realignments," said WHA President/CEO Eric Borgerding. "Over a year later, and after much lobbying by WHA and our members, this provision brings a welcome measure of relief and more certainty for some of those mid-build projects. We thank Wisconsin’s House Members for hearing our concerns and supporting this partial fix."

WHA continues to support further amendments to Section 603 to provide additional flexibility for certain HOPDs and to exempt outpatient mental health care services called "partial hospitalization programs."

The U.S. House approved the 21st Century Cures package, HR 34, on November 30 by a strong, bipartisan vote of 392-26. The U.S. Senate is expected to take up the bill as early as next week.

WHA webinar on Section 603/OPPS/Mid-Build scheduled December 8
To learn more about the mid-build language contained in the 21st Century Cures legislation as well as the underlying law and regulations, WHA hospital and corporate members are invited to a one-hour webinar on this subject scheduled December 8 at 10:00 a.m.

The WHA webinar will focus on the statutory provision, Section 603; how CMS will implement Section 603; which HOPDs are or are not grandfathered and what reimbursement changes are in store starting in 2017 for non-grandfathered locations. Additionally, the webinar will highlight the state of play on the mid-build fix in the 21st Century Cures package and WHA’s efforts to date on this issue.

While the webinar—Looming HOPD Reimbursement Changes: Section 603, OPPS Rule and Where Things Stand—is free to WHA hospital and corporate members, registration is required. Register at

An audio recording of the webinar will be available after the event, but you must pre-register to receive the recording.

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Opioid Abuse Listening Session Held at Capitol
Innovative Aurora Sinai program for addicted mothers improves outcomes, reduces MA costs

The co-chairs of the Governor’s Task Force on Opioid Abuse, Lt. Governor Rebecca Kleefisch and Rep. John Nygren (R-Marinette), held a listening session November 28 at the Capitol to provide members of the public with an additional opportunity to provide input on addressing opioid abuse in Wisconsin.

Family members, health care providers, and law enforcement each provided testimony during the listening session, offering insights into the opioid abuse problems and suggested opportunities for addressing opioid abuse.

Andy Anderson, MD, CMO, Aurora Health Care and a 2017 physician leader on the WHA Board of Directors, thanked the co-chairs for their work and shared efforts that Aurora Health Care has taken to address prescription opioid abuse that are "examples of proactive action taken by those of us in the provider community."

Anderson in particular focused on an innovative program at Aurora Sinai Medical Center created last year that works with pregnant women addicted to opioids to improve outcomes and reduce costs.

"The Maternal Addiction Recovery Center, or MARC, is a center at Aurora Sinai Medical Center that is designed to wean moms off of the narcotics while also providing ongoing support for the baby and the mom," said Anderson.

"And while the program is new, it is showing notable success. Based on our current figures, dependent babies whose moms are in the MARC program have a 9.9 day shorter stay in the hospital and more than a $13,000 reduction in medical costs," said Anderson. "This means better outcomes for our patients and reduced costs for payers such as Medicaid."

In October, Joan Coffman, president/CEO, HSHS St. Joseph’s Hospital in Chippewa Falls and WHA representative to the Governor’s Opioid Task Force, presented to the Task Force a WHA summary of steps the Task Force could take to help Wisconsin sustain and expand access to treatment for opioid abusers, as well as a summary of education programs, examples of collaboration and local efforts that hospitals and WHA are undertaking to address Wisconsin’s opioid abuse epidemic. Those summaries and their accompanying memo can be found at

The next meeting of the Governor’s Opioid Task Force will be December 16 in La Crosse.

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Oland to Chair WHA Rural Council

Charisse Oland, CEO, Rusk County Memorial Hospital, Ladysmith, will chair the WHA Council on Rural Health in 2017. She succeeds Bob Van Meeteren, president, Reedsburg Area Medical Center, who will serve as WHA chair-elect in 2017.

Before joining Rusk County Memorial Hospital, Oland led a successful health care consulting company. She has also held several executive leadership positions at Wisconsin hospitals and health systems, including ProHealth, HSHS-Wisconsin and The Rehabilitation Hospital of Wisconsin.

Oland has been a member of the WHA Board since 2016 and has served on WHA’s Network Adequacy Council.

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Dec. 7 MACRA Webinar Examines Advanced Alternative Payment Models (APMs)

On December 7, WHA is offering members the complimentary webinar "MACRA – Final Rule Update and Pathway Toward Alternative Payment Models (APMs)." The session will provide an overview of APMs under the Medicare Quality Payment Program (QPP); the difference between the Merit Based Incentive Program (MIPs) and the APMs; review updates included in the final rule, which was released October 14; and describe the requirements for qualifying under APMs.

Brian Vamstad, federal government relations consultant for Gundersen Health System, and Joanne Alig, WHA senior vice president, policy and research, will co-present the one-hour complimentary webinar.

Register today at: This complimentary webinar is open to all WHA hospital and corporate members, but pre-registration is required. An audio recording of the webinar will be available after the event, but you must pre-register to receive the recording.

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Register Today for WHA Physician Leadership Development Conference
March 10-11, 2017

Register today for WHA’s Physician Leadership Development Conference, scheduled March 10-11, 2017 at The American Club in Kohler.

This year’s conference will include a full day with Kevin O’Connor focusing on the skills needed to elicit connection, communication and cooperation from fellow medical professionals in a session titled "Emotional Intelligence: The Final Frontier." In addition, a half-day discussion, led by Jennifer Grebenschikoff, will focus on the physician leader’s role in strategic physician recruitment and retention. Continuing medical education credits are available again this year.

Both O’Connor and Grebenschikoff are nationally-recognized faculty from the American Association for Physician Leadership, formerly the American College of Physician Executives, and both will discuss important and practical leadership skills that help physician leaders move beyond their clinical training and take a new approach to managerial decision making and problem solving.

Online registration is available at or directly at, and discounted registration is available to those registering by January 15.

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East Tennessee Wildfires Impact Local Hospital Employees
Fund created to help hospital employees who lost their homes

Wildfires that started November 28 have devastated eastern Tennessee, destroying hundreds of buildings in and near eastern Tennessee’s resort towns of Gatlinburg and Pigeon Forge in just 24 hours. The fires have also destroyed several LeConte Medical Center, part of Covenant System, employees’ homes in Sevierville. The media is reporting that three people were killed in Sevier County, Tennessee, and officials are bracing for the possibility of more blazes.

The Tennessee Hospital Association is reaching out to its colleague organizations across the country to make the hospital family aware of the situation and of opportunities to assist those impacted.

A fund has been established to assist employees of LeConte Medical Center who have been affected by this tragedy. If you would like to help, please see the information below.

LMC Employee Assistance Fund
c/o Dr. Robert F. Thomas Foundation
LeConte Medical Center
744 Middle Creek Road, Ste. #206
Sevierville, TN 37862

Letters of support and encouragement are also welcome and can be sent to Jenny Hanson, president and CAO, at the above address.

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