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The Alliance News: April 2011
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In this issue:
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On My Mind: Health Policy Resolutions

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By: Cheryl DeMars, President & CEO

Two and a half years ago, we developed a Health Policy Committee made up of Alliance member representatives. One of the functions of the health policy committee is to develop resolutions — formal policy statements related to the legislative landscape. We draw upon these resolutions when speaking with members of the legislature and other policy makers to show what we value when considering policy changes, including laws and regulations.

Resolutions are developed within the parameters of our general health policy platform, which is focused on controlling costs by increasing health care transparency and improving the quality and safety of care.

Once resolutions are drafted by the Health Policy Committee they are passed to the Alliance Board of Directors where they are reviewed, amended as needed and endorsed. Starting with our Annual Meeting this fall, we will present resolutions for a vote by the membership.

In total, four resolutions have been endorsed by the Alliance Board thus far:

  • Resolution 1.01: Facility Fees Billed to Patients – encourages policy makers to pass legislation that discloses these fees at the time of an appointment.
  • Resolution 1.02: Empowering Consumers and Employers with Actionable Cost and Quality Information – provides considerations for designing cost and quality transparency initiatives.
  • Resolution 1.03: Support of the Wisconsin Health Information Organization (WHIO) – encourages coordination of transparency efforts with WHIO.
  • Resolution 4.01: The Design of Exchanges in Wisconsinsee article below.

The resolution regarding the design of exchanges in Wisconsin is especially timely. Although insurance exchanges aren’t due to be established until 2014 according to the Patient Protection and Affordable Care Act (PPACA), states need to begin working on their development now. And although the exchange will initially be open only to small employers and individuals, they have the potential to impact the market and therefore, deserve careful consideration by Alliance members.

To help you understand more about these resolutions and the topics they cover, we are beginning a series of articles on our resolutions, starting with the article below on Resolution 4.01: The Design of Exchanges in Wisconsin.

If you have any questions, please let us know.

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Resolution: 4.01: The Design of Exchanges in Wisconsin

What are exchanges?

An exchange is a place where those buying health care insurance can connect with those selling it. An exchange is not necessarily a brick and mortar facility, but rather a website where consumers can compare plans, learn more about the costs of those plans, and purchase one if they choose to do so.

The Patient Protection and Affordable Care Act (PPACA) calls for each state to create an exchange by January 1, 2014.

Who will be able to buy health care insurance through the exchange?

Initially, exchanges will be open to individuals and small employers (up to 50 or 100 employees depending on state interpretation). Eventually, exchanges would be open to larger employers.

The following individuals will be eligible to buy insurance through the exchange in 2014:

  • Unemployed or self-employed Individuals.
  • Individuals with employer coverage deemed "unaffordable", i.e. who must pay more than 9.5 percent of their income for premiums, or those whose plans do not cover more than 60 percent of the cost their benefits.
  • Employed individuals who do not have access to coverage through their employer or who forgo the offer of coverage from their employer.
  • Employed individuals who work for an organization that employs fewer than 50 full-time employees.
  • Individuals with incomes that are between 250 percent and 400 percent of the poverty level (that's $55,125 to $88,200 for a family of four) would be eligible for premium subsidies through the exchanges. Those that have an offer of "affordable" employer-sponsored coverage would not be eligible for subsidies.
What does The Alliance’s resolution say about exchanges?

The Alliance’s resolution says that if an exchange or exchanges are developed in Wisconsin, policy makers should create exchanges that help consumers understand insurance and promote high-value providers. Specifically, exchanges should:

  1. Improve health, health care and control costs.
  2. Minimize the risk of negative market consequences.
  3. Advance public reporting and consumer understanding of cost and quality information.
  4. Reward high-value health care providers.
  5. Encourage and support consumers to be good stewards of their health and health care dollars
  6. Be voluntary.
  7. Simplify and streamline choices for consumers.
  8. Operate efficiently

You can read the entire resolution on the design of exchanges here (.pdf).

Why did The Alliance comment on this particular issue?

The exchange will be a powerful influence when it comes to setting policy for health care in Wisconsin. Therefore, we want the exchange to contribute to the goal of system-wide improvement in quality and cost control so that the value of health care improves for all Wisconsinites.

If you have any questions or comments about this resolution or about the resolution process, please contact me.

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Answering the Big Questions of Value-Based Benefit Design
How does it work? Does it work? And how do you start?

April 13, 2011
Many hope that value-based benefit design (VBBD) can help people to make better choices through better plan design. But there are still a lot of questions about VBBD:

  • Do people make better decisions when they are asked to pay less for care with proven outcomes? Does paying more for inappropriate care make them avoid it more often?
  • Do these incentives and disincentives save employers money?
  • And if they do, how do employers put value-based benefit design into action?
Join Us and Learn the Answers to these Questions and More

You’ll have a chance to listen to leaders in this field and participate in an interactive workshop that will help you find solutions to putting the concepts into action at your organization.

Alliance Learning Circles

Learn more and register today.

 
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The Alliance Annual Seminar
The Future of Health Care: Pulling the Rabbit Out of the Hat

May 11, 2011

Pulling a rabbit out of a hat isn’t magic. All you need to do is learn the trick.

Joe Flower, Health Care Futurist

Everyone wants abundant, effective, and efficient health care, but how do we get there? Can we? According to our Annual Seminar speaker, Joe Flower, a health care futurist, we can. But we will all need to take steps to get there.

Join us to learn where he sees the rabbits — opportunities — waiting to be found inside the hats — challenges — and what we will need to do to get there.

Watch for more information and registration information coming soon.

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Save the Date: June 7, 2011

This event will bring policymakers together to provide their perspective on the dynamic, post-reform world and how it will affect the health care market. Department of Health Services Secretary Dennis Smith, Steven Brenton president of the Wisconsin Hospital Association, and Tim Bartholow, MD, the Wisconsin Medical Society’s senior vice president of member services, policy planning and physician professional development are scheduled to appear.

Watch for more information and registration information in the coming weeks.

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Last month we told you about inconsistencies between the Patient Protection and Affordable Care Act and the state law related to adult dependent care coverage.

Even though a bill (LRB 0867) to federalize Wisconsin's adult dependent requirements has been introduced to address this issue, Wisconsin is one of a number of states that have not yet adopted the new federal tax code for the purposes of adult dependent coverage. As a result, the value of the certain dependent care coverage is considered income for the employee and employees are obligated to pay tax on these amounts. This situation occurs when the dependent provided coverage does not meet the definitions of "qualifying child" or "qualifying relative" as described here. At this time, employers should be withholding income tax for this "imputed income", and the amounts must be reported on W-2s.

The Wisconsin Department of Revenue (DOR) has issued additional guidance on this issue, although DOR has declined to advise employers about how to compute the fair market value of dependent coverage. We encourage you to check with your tax advisors, TPAs, payroll administrators or other benefit partners for additional guidance on this computation. The DOR can be reached at 608.266.2776.

Legislative action could affect employers withholding obligations for 2011. If the state legislature codifies the new federal tax definition of dependent before August, the change could be retroactive to January 1, 2011. The DOR believes that if that happens, it is likely that employers would stop withholding and employees would then be eligible for a larger refund. We will continue to keep you updated on this issue as the legislation advances.

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Did you know many health clubs and fitness centers will give your employees a discount just for being a member of The Alliance? They don't need to sign-up through their health plan; they can simply show their Alliance medical ID at the door.

Discounts on services are available at more than 50 fitness locations in south-central Wisconsin. The same savings extend to hearing centers, nutrition and weight-loss clinics, karate classes and yoga sessions.

Offers vary, so check with participating businesses for details. Information about this program can also be found at www.the-alliance.org by clicking "Improve Your Health and Wellness" under the "Quick Links" on the home page, and then clicking the "Healthy Living Discounts" link.

Be sure to let your employees know about these great "Healthy Living" discounts - they'll find it's the perfect way to stay fit, and keep their wallets in shape too!

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The Alliance website has a number of resources for your employees that can positively impact their health:

  • Patient Safety Toolkit - Here they'll learn how to avoid medical errors, understand a diagnosis, manage medications, prepare for medical visits, and talk to their doctor.
  • How to Be a Better Health Care Consumer - These presentations teach individuals how to be a wise health care consumer. They'll not only learn that, but also more about the safety and quality of health care and how to maximize each health care visit.
  • BabyLove - This service is designed to get pregnancy started off right. It includes a health screening and a free copy of What to Expect When You're Expecting or What to Expect - The First Year or What to Expect - the Toddler Years.
  • Diabetes Toolbox - If an individual has diabetes or knows someone who does, this provides tools to help them learn how to manage and live well with it.

In addition, they can also find a health care professional through our Find a Doctor function, learn more about quality and cost in QualityCounts® and get assistance from our customer service staff. This sheet (.pdf) includes complete details about what's available for individuals on our website. You may also order copies of this piece. To do so, contact Tierney Jensen, 800.223.4139, x 6642.

Alliance staff is also available to present to your employees on how to make better health care decisions and how to use the QualityCounts® report. For information on our Better Health Care Consumer presentation, contact Jesse Oberloh. For QualityCounts®, contact Bobbi Jones.

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The Alliance recently began serving on the leadership team for a new 2010 Collaboration Development grant awarded to Mental Health America of Wisconsin which is focused on improving employer mental health practices.

The focus of the grant will be on building a public-private partnership that builds a strategic plan to promote workplace mental health practices and explore barriers and facilitators to implementation of evidence-based or best practices in workplace mental health programs.

The Alliance’s role on the team will be to help administer market research through interviews, focus groups and surveys. The Business Health Care Group of Milwaukee is also serving as a member of the leadership team as are members of the Wisconsin Department of Health Services.

The grant was awarded by the Wisconsin Partnership Program through the UW School of Medicine and Public Health. If you have any questions, or would like to get involved, please contact Teri Schacker, who is serving as The Alliance representative.

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The Alliance’s preferred wellness vendor, Health Solutions, Ltd. has changed its name to Trotter Wellness®. The name change is cosmetic in nature and is not related to a change in ownership. Their contract with us has not changed, and if you are currently using their services you should not notice any changes.

We will be working to update our marketing, website and other promotional materials related to Health Solutions, in the near future.

Fighting the Rain with Fitness Indoors!
April showers not only bring May flowers but it also kicks off triathlon and 5k season in Wisconsin. The importance of physical activity doesn’t change with the weather, so adjusting one’s fitness routine during the seasonal rainy months is a great idea. By spinning one’s creative wheels, many individuals can find plenty of options for physical activity while it’s raining outside.

Boost fitness morale with your employee group by offering indoor fitness ideas to beat the rain. For example:

  • Have cable? Many cable providers have at least one or two fitness channels that offer television fitness shows. Urge employees to find what time works best for them and check out their local cable provider to see what is showing. Also, many cable providers offer these shows on-demand.
  • Create your own home gym! Libraries are a great fitness resource. Many times fitness DVDs or VHS tapes can be checked out for free. To increase muscle strength, grab an empty milk jug and fill it with water. For a lighter weight, use different sized canned goods. Employees can create their own set of free weights in the comfort of their own home.
  • Make a trip to the local mall, but leave the wallet at home. Mall walking has quickly become a fitness phenomenon with the economic changes. If money is a barrier to joining a gym, pack tennis shoes and walk the mall for 30 minutes to increase cardiovascular endurance.

Help your employees stay active in the rainy months by encouraging fitness all year-round. For more information about indoor fitness, Trotter Wellness®, or about their partnership with The Alliance, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.

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Mary Wong-Young

Mary Wong-Young has joined The Alliance as member solutions specialist. She brings more than 20 years of experience in the health insurance industry working previously at American Family Insurance in product development, project management, claims adjusting and employee benefit design and implementation. Mary's expertise and experience will be an excellent asset to members of The Alliance.

In her position, Mary will be assisting the marketing and member services department in researching, developing, and delivering new products and services that support the mission of The Alliance and the needs of our members.

Please join us in welcoming Mary, 800.223.4139 x 6636.

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Diane Loram, business development manager, is leaving The Alliance at the end of March. Diane, who has been a part of The Alliance family for 3 years, will be taking a new position elsewhere. We thank her for her service and wish her the best in her new endeavors. If you have any questions, please contact Jesse Oberloh, 800.223.4139 x 6645.

We have begun recruiting for a new business development manager. The posting may be found here.

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WELCOA has two new free wellness resources:

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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.

More than a Decade after To Err is Human – Have Medical Errors Improved?
In 1999, the Institute of Medicine reported that medical errors caused more than 98,000 deaths and injured more than 1 million each year. While that landmark study has not been repeated, two recent studies put into question how much progress has been made. Read more.

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QualityCounts logoThe Alliance encourages employers to distribute the monthly QualityCounts® for Employees informational piece to their employees.

This new wallet card helps employees keep QualityCounts® information close by.

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

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

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LinkedIn buttonDiscuss this newsletter in the Alliance Member Forum on LinkedIn.


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1000credit_145x108.pngDon't forget about The Alliance Referral Program.

Help your cooperative grow by referring a member candidate to The Alliance. Alliance members who refer a prospective member receive a $1,000 credit if the company joins The Alliance. To refer someone, use our form.


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Each month, The Alliance News delivers the latest news about Alliance services, programs and events, as well as information on health benefit trends, issues and ideas.

Subscriptions are free for Alliance employer members. 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
Jesse Oberloh, Member Services Manager


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