Physicians Plus Moves Forward

Jim Woodward, Meriter President and CEO

The following Guest Editorial by Jim Woodward, Meriter President and CEO, first appeared in the Wisconsin State Journal on Friday, July 6.

Readers of this publication over the past year have seen unprecedented sparks fly between Meriter Health Services and UW Hospital. Wisconsin and the country have grown weary of institutions squabbling to protect self-interest. At Meriter, so have we.

Responsible debate involves the presentation and evaluation of facts, not rumor and enflamed opinion. So we intend to keep the discourse civil and stand by the facts.

Meriter’s health plan, Physicians Plus Insurance Corporation decided to manage access to high-cost facilities like UW Hospital because our employers and members demanded high-quality, high-value care. UW Hospital’s response to what we did has been to promote unfounded fear that patients will be unnecessarily sent out of town and that Physicians Plus patients who need UW Hospital services will be denied by some murky panel of deniers. Untrue and untrue.

The first option for our members who need hospital services unavailable at Meriter will continue to be UW Hospital. The small number of members requiring sub-specialty care outside the Meriter integrated delivery system will have access, with approval from Physicians Plus clinical staff, to centers of excellence including UW Hospital and American Family Children’s Hospital, as well as Mayo Clinic, Children’s Hospital of Wisconsin and Froedtert Hospital/Medical College of Wisconsin.

Ultimately, Meriter and Physicians Plus are expanding access while keeping care local whenever possible. There is little change to the physician network. Less than 6% of Physicians Plus members will need to begin a new primary care physician relationship.

To be proactive in minimizing the increase in overall health care costs, Physicians Plus needed to redefine its relationship with UW Hospital, an organization focused on an academic model of medicine. Physicians Plus’ former “free-flow” access for all services at UW Hospital was not free; it was very expensive for the patient and the employer. The old model was unsustainable without significant rate increases for employers and their employees. In fact, routine services such as lab tests and imaging scans at UW Hospital, where a doctor is not even present, can be absorbed at Meriter for less than half the cost.

An independent review of Physicians Plus’ care navigation approach indicates that this new relationship with UW Hospital will remove $20,000,000 to $30,000,000 in medical costs from our HMO system. That’s $30,000,000 returned to this community via premium savings. Meriter Health Services will put forth every effort to continue cooperation with UW Health on various programs important to the interests of the community.

After Meriter’s selection for two straight years as one of America’s 100 Top hospitals (of 5,500), it should be clear that Meriter has evolved into a first-rate, nationally recognized, comprehensive health system. Thus, Physicians Plus can move forward with full confidence in its members’ well-being. It is a bold step by an organization that knows how to respond to the changing needs of the people we serve.

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