Collaborating to Promote Transparency on Health Care Quality and Costs

March 9, 2007

Overview


Based on the article "Wisconsin: Private and Public Sectors Partner to Promote Transparency" in the Summer 2006 issue of the newsletter States in Action. Public and private stakeholders—including businesses, hospitals, physicians, insurers, state employees, and the state Medicaid program—are collaborating to collect, compare, and publicly report information about the costs and quality of health care in Wisconsin. The state committed public funds to the creation of a database of health care information intended to enhance the transparency, quality, and efficiency of the health care system.


The Issue: In Wisconsin, there are a number of ongoing efforts intended to promote the transparency and, eventually, improve the performance of the health care system. Public and private stakeholders are collecting information on the quality and costs of health care at the physician, hospital, and health plan levels in order to make reliable, comparative data available to providers, employers, and consumers. The groups needed to work together and build on each others' work, rather than duplicate efforts.

Target Audience: Wisconsin businesses, hospitals, physicians, insurers, and state employees, and state Medicaid program

The Intervention: In late March 2006, Governor Jim Doyle signed the Health Care Transparency Bill (AB 907). The legislation dedicates state funds to the Wisconsin Health Information Organization (WHIO), a coalition of managed care companies, employer groups, health plans, physician associations, hospitals, and doctors. Created in 2005, the coalition is building a centralized health data repository based on voluntary reporting of private health insurance claims. The database will include health care claims as well as pharmacy and lab data from insurers, self-funded employers, and health plans. Such information will be used to develop reports on the costs and, eventually, the quality of care. The goals are to encourage providers to improve their performance and enable employers and consumers to make informed purchasing decisions.

Both the Wisconsin Department of Health and Family Services (DHFS), which administers the state's Medicaid program and State Children's Health Insurance Program (SCHIP), and the Wisconsin Department of Employee Trust Funds (ETF), which as the state's largest employer manages health benefits for state and some local employees and retirees, are participating in the initiative. DHFS and ETF will contribute data on the costs of publicly paid health care through Medicaid and public employee benefit systems. For ETF, this is one component of a "value-based purchasing" model it has been employing for nearly four years.

To finance the effort, each private member group makes a contribution, which the state will match through funds derived from assessments on physicians and a small contribution by ETF.

By supporting the WHIO initiative, the state hopes to:

  • facilitate quality improvement efforts by private providers;
  • help consumers make well-informed purchasing decisions;
  • inform public health efforts such as disease surveillance; and
  • secure value for money in public programs such as Medicaid, the state's biggest purchaser of health care.

For Further Information: Contact Julie Bartels, Executive Director, WHIO, julie.bartels@thedacare.org, 920-336-0409.

March 2007