Use Of More Cost-effective Care Channels - WPS

Bending the Cost Curve witha Proven Business Strategy.Using incentives to motivate employees and consumers is not a new concept in the businessworld. Employers commonly use financial incentives to improve performance andefficiency in the workplace, or to motivate consumer purchasing. To squeeze more value out ofhealth plans, however, many employers today often increase cost-sharing and reduce benefitsto achieve desired savings. While this approach can deliver short-term savings, it can also havea negative effect on employee morale and health. New health benefit strategies have emergedthat help control health care costs while delivering higher quality care to employees and theirfamilies. Two of the most promising new concepts are pay-for-performance and value-basedbenefits design. The central idea behind each is the same: targeted incentives drive desiredbehaviors.WPS Health Insurance and the providers in the Northeast Wisconsin Health Value Network(NEWHVN) have collaborated to offer an innovative health insurance plan, the WPS ValueIncentive Plan. It incorporates both concepts, leading to:• Use of more cost-effective care channels;• Higher rates of screening for catastrophic illnesses and preventionof their associated costs;• Improved management of costly chronic health conditions;• A healthier and more wellness-oriented workforce.With a targeted, strategic approach, the WPS Value Incentive Plan leverages the power ofincentives to drive higher quality care and motivate employees to live healthier, more activelives. What’s more, you see your business’s health care cost curve start to bend in a morefavorable direction.IMPORTANT: This brochure provides only a general descriptionof benefits, limitations, and exclusions. You can find a detaileddescription of coverage in the applicable policy issued to you.Coverage is subject to all the terms and conditions of the policyand any endorsements.If there’s ever a discrepancy between the policy and thisbrochure, the policy has final authority.WPS Value Incentive PlanRewarding Prevention, Wellness, and Clinical Excellence1717 W. BroadwayP.O. Box 8190Madison, WI 53708-8190www.wpsic.com© 2009 Wisconsin Physicians Service Insurance Corporation. All rights reserved. 24360-021-0911Printed on recycled paper.

Exemplary Care from Quality-Focused Physicians.The WPS Value Incentive Plan features an innovative newreimbursement model, known as pay-for-performance (P4P),that’s designed to improve clinical quality and efficiency. UnderP4P, physicians receive full payment for services only afterthey’ve exceeded certain pre-defined quality targets, drivingincreased compliance with national standards for clinical care.WPS and NEWHVN have agreed to a fee schedule that rewardsphysicians that exceed the performance of 75% of their peersfor the treatment of chronic conditions such as diabetes, heartdisease, and hypertension, and earlier diagnosis of seriousillnesses including cancer.By offering incentives to providers, your employees benefitfrom higher quality care, which can lead to lower health carecosts for you over time.The WPS Value Incentive Planoffers a new, incentive-drivenapproach, featuring:• Pay-for-performance model thatpays physicians in full only afterthey’ve exceeded pre-set clinicalquality targets;• Value-based benefits designthat motivates better diseasemanagement with $0 or reduceddrug copays for maintenance drugs;• Biometric Health Risk Appraisalsto raise employees’ awareness ofhealth risks and potential behaviorchanges that can improve healthstatus;• First-dollar coverage for preventivecare to help motivate employeesto get the care they need to stayhealthy;• A low $15 copay at networkFastCare clinics to encourageemployees to choose more costeffectivecare for minor illnesses;• A turn-key wellness campaignkit with easy-to-follow guides andother materials to help you organizea variety of fun, engaging worksitewellness activities.The Right Care, at the RightPlace, at the Right Cost.Receiving care for relatively minor illnesses ininappropriate settings, such as a hospital emergencyroom, is a significant driver of health care costs. TheWPS Value Incentive Plan encourages your employees touse lower-cost care channels for minor illnesses such ascolds, sore throats, fevers, and urinary tract infections.Employees pay a copay of just $15 when choosing networkFastCare clinics instead of urgent care or the ER. Thissimple incentive encourages your employees to seekmore cost-effective care when life’s minor emergenciesinevitably arise.An Ounce of Prevention...... is worth a pound of cure. Ben Franklin was right then,and he still is today. Regular check-ups help employeesand their doctors catch serious illnesses early, whenthey’re easier and less expensive to treat. Both thetraditional PPO and the HSA-qualified high-deductiblehealth plan options available with the WPS ValueIncentive Plan feature first-dollar coverage for preventivecare. It’s an effective way of encouraging employees toget the care they need to stay healthy while keeping yourcompany’s long-term health care costs in check.Improving Management ofChronic Conditions.Experts agree that one of thebest ways to lessen the impactof the costs associated withchronic health conditions isto improve compliance withmedication regimens. That’swhy the WPS Value IncentivePlan features a value-basedbenefits design for certainprescription drugs. The PPOoption has $0 copay on genericmaintenance medicationsfor diabetes, coronary arterydisease, hypertension, and asthma. For the sameconditions, the copay for preferred brand drugs is reducedto the generic-level copay. By targeting potentially highcostconditions with incentives, this value-based benefitapproach motivates those with chronic health conditionsto improve management of their disease, while helping toreduce the use of costly medical services.AboutNortheast wisconsin health value networkKnowledge: The First Stepon the Road to Better Health.Another effective method for bending the health carecost curve is to help employees understand the healthrisks they face, and the changes they can make toimprove their health status. As WPS Value IncentivePlan members, each employee will have the opportunityto receive a free, biometric Health Risk Appraisal(HRA).* After completing the HRA, a health coach willfollow up to review the results and offer guidance onhow to improve the employee’s health. This step helpsyour employees understand any health risks they mayface, and provides them with the knowledge and toolsto address risk factors.Northeast Wisconsin Health Value Network (NEWHVN) is made up of the BellinHealth and ThedaCare health systems, five major health care facilities, and 630physicians. Together, members of NEWHVN work to create value through qualityimprovement and increased efficiency of care. Under the WPS Value Incentive Plan, NEWHVN serves smallerbusinesses in Brown, Outagamie, Shawano, Waupaca, and Winnebago counties. To learn more about NEWHVN,visit www.newhvn.com.Inspiring Employees to Live Well.When you enroll in the WPSValue Incentive Plan, weprovide you with a varietyof resources to help youremployees start focusing onmaking positive changesand healthier choices. You’llget e-mail-ready healthand wellness tips, wellnesspromotion posters, andaccess to the online WPSHealth Center—a valuableresource loaded with peerreviewedhealth informationand action-oriented decision support tools. You’ll alsoreceive a wellness campaign kit, with easy-to-followguides and other materials to help you organize a varietyof fun, engaging worksite wellness activities. Alongyour company’s journey to better health, you’ll have thesupport of the WPS Wellness team, whose expertise andcounsel is always just a phone call or e-mail away.Incentives Lead theWay to Affordable,High-Quality Health Care.The time has come to stop the unsustainable trend ofrising health care costs. With the strategic applicationof leading-edge health plan innovations, the WPS ValueIncentive Plan is a promising new model of integratedhealth care that can deliver that elusive objective soughtby employers and policy-makers alike—high quality,preventive-oriented care delivered at a lower cost.For more information about WPS Value IncentivePlan, or to request a no-obligation quote, pleasecontact your agent or call 1-800-950-0117 .*Free HRAs are available only from NEWHVN providers.