HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, reports Humana and the Business Health Care Group of Southeastern Wisconsin continue to add business to the coalition's health plan, but have rebuffed a major local hospital system that had wanted to join its select network of providers. According to the latest Wisconsin Health Plan Analysis, Wheaton Franciscan Healthcare was not included in the business group's high-performance network, which includes competitors Aurora Health Care and Columbia St. Mary's.
"As one of the largest integrated regional health care systems in Wisconsin, it's a setback for Wheaton Franciscan not to be included in the business group's network of providers, particularly after a strong push to get in," states Ric Gross, HealthLeaders-InterStudy research analyst. "When the coalition was formed in 2003, they stated that not every hospital system would be included and they have stayed true to their words."
Humana, the plan administrator for the business group, has compiled a network of 4,000 providers and 26 hospitals, including only those that met certain efficiency standards and cost-savings goals. According to Humana spokesman Mark Mathis, adding Wheaton Franciscan to its narrow network would jeopardize the pricing arrangements already in place with existing providers.
Even more disappointing to Wheaton Franciscan, in early July, Humana announced it had landed the contract for the city of Milwaukee, which will transition 12,000 employees, retirees and family members to its HMO health benefits beginning Jan. 1, 2007. Milwaukee will be the first public-sector employer to sign up with the group.
Other news in the Wisconsin market:
State officials continue to work to keep SeniorCare Pharmacy Plus, a prescription drug benefit plan for low-income seniors over 65, intact alongside Medicare Part D by requesting an extension to the state program. Governor Jim Doyle, in a heated re-election campaign with Republican challenger Mark Green, continues to float healthcare proposals prior to the election, including an initiative allowing more farm families to obtain coverage through the state's popular BadgerCare program.
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