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Wis. Takes Collaborative Approach to Health Costs

Posted at: 08/28/2013 8:23 AM
Updated at: 08/28/2013 9:42 AM
By: SCOTT BAUER, Associated Press



MADISON, Wis. (AP) - A massive statewide database of health care claims years in the making is set to go public in 2014, allowing Wisconsin residents to do comparison shopping before they choose a doctor or schedule surgery.

The Wisconsin Health Information Organization has accumulated 250 million claims for care provided to 3.7 million Wisconsin residents over the past several years. Every current Medicaid claim is in the database, along with 70 percent of commercial claims, with Medicare information hopefully being added soon.

The database will operate as a complement to the health care exchanges set to open for enrollment in October under the Affordable Care Act. The goal of having government, employers and insurance companies share their claims data was to increase transparency, control costs and help consumers make more informed decisions.

It was a tough sell at first, but that kind of collaborative thinking has put Wisconsin ahead of many other states in trying to control health care costs and improve quality, said Dr. John Toussaint, the first organizer of the database and a former health care executive.

Doctors are forced to re-examine their practices when they see the same care is being provided by others at a fraction of the cost in some cases, Toussaint said.

"When you actually can show an orthopedic group that they're 500 percent higher than some other place in the state, that gets their attention," Toussaint said. Cost-cutting efforts such as the WHIO database are taking on an even greater urgency nationwide as key provisions of the health care law are set to roll out in coming months, raising fears that health care expenses will go up.

Health care spending in Wisconsin averaged $7,233 for each person in 2009, according to a report by the Centers for Medicare and Medicaid Services. That was 6 percent higher than the national average of $6,815.

Health care spending grew an average of 6.7 percent a year in Wisconsin between 1991 and 2009, slightly ahead of the national average of 6.5 percent.

While studies have shown that Wisconsin has high quality health care overall, it doesn't rank as well in quality of care for blacks and Hispanics, said Donna Friedsam, the Health Policy Programs director at the University of Wisconsin Population Health Institute.

Both Friedsam and Bobby Peterson, a Madison attorney for a public interest law firm, agree that in the short term there will be some cost increases for some people under the health care law, such as the "young invincibles" who are healthy and in their 20s and 30s, but the law will also force providers to remove waste and offer more quality care for less.

Finding a solution to curbing costs is a group effort, Toussaint said.

"It's a gang tackle," he said. "It's not the insurance companies' fault. It's not the providers' fault. It's not the government's fault."

Wisconsin's integrated approach to health care puts it in a strong position as the health care law is implemented and sets it apart from many other places that aren't as far along, said Rick Abrams, chief executive officer of the Wisconsin Medical Society, which has used the WHIO database.

"The country is just beginning to catch up with Wisconsin," Abrams said.

The recently passed state budget invests $5 million in the WHIO database. Once the public website is created, people will be able to type in the name of a clinic and see how its doctors are rated on a variety of quality and efficiency measures, said Jo Musser, chief executive officer of WHIO.

Innovations such as the database put Wisconsin "far ahead of where other folks are coming from," when it comes to grappling with health care cost containment, Musser said.

(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)