Companies hope to save money by setting up insurance plans that guide employees to the top PC physician
The employers are expecting savings of 15% per employee in annual medical costs.
A recent study commissioned by Wisconsin’s employer-led Business Health Care Group showed that health plans in Wisconsin could save $382 million out of the $1.5 billion spent on treatments managed by primary care doctors if care was redirected to the higher-performing physicians, or if all physicians adopted the same treatment approaches used by the high performers.
Enrollees must establish a relationship with a primary care physician in the network. Ordinary services, such as mammograms, don’t need primary care referrals, but other services that require specialists do need referrals. Specialists report back to the primary care physicians. The organizers said this will keep primary care physicians in the loop about all the care their patients are receiving.
In the program, hospital groups can keep referrals for specialists to those within their systems,
Physicians who aren’t selected for the program can look at the data and see where they need to improve.
The program is looking to expand into other parts of the state as well as including nurse practitioners and physician assistants.