On Sept. 13 Humana Inc. announced the creation of a health insurance product, called Humana Wisconsin Value Network, which promises to reduce health care costs for employers and patients. The product excludes the Froedtert & the Medical College of Wisconsin health network and Children’s Hospital of Wisconsin.
Froedtert Health is disappointed that Humana, an organization with whom we have had a long relationship, has chosen to exclude the region’s only academic medical center and pediatric specialty provider from this network.
Employers who would consider the new Humana plan as a cost-cutting option should consider the consequences of the tradeoff they are asking their employees to make. Anyone in this new network who needs life-saving care at our Level I Trauma Center, or a bone marrow transplant, or seeks to enroll in a clinical trial at our Cancer Center would have no coverage. Under this plan, people would not be covered for primary or specialty care from their doctors at any Froedtert & the Medical College of Wisconsin health center or hospital without a referral from an in-network physician.
Froedtert Health believes participants in the Humana Wisconsin Value Network are likely to expect the Froedtert & MCW health network, Children’s Hospital and MCW doctors to be in their health plan. Participants would face high, unexpected out-of-pocket costs for services they assume are in-network.
Insurers’ Interpretations of Cost Savings Varies
While many insurance companies view cost savings as the discounted rate at which health systems and physicians are willing to be paid for their services, others understand cost savings in a broader sense. Providing care in an outpatient (clinic) setting costs less than inpatient (hospital) setting and is usually preferred by patients. The Froedtert & MCW heath network provides more cancer care in an outpatient setting than any other provider in southeast Wisconsin. In addition, the Froedtert & MCW heath network is able to provide more care in an ambulatory surgery center setting than Ascension Wisconsin, which has none of these facilities, as well as at lower rates than existing Aurora-only facilities that bill at higher, hospital-based rates. These options lower the total cost of care and is more impactful than discounting inpatient rates with insurers.
An Academic Medical Center: An Essential Community Resource
The collective impact of the academic medical center’s mission to educate, research, provide patient care and engage in the community improves health and well-being while expanding the boundaries of knowledge.
- The commitment of Froedtert Hospital, the largest teaching hospital in Wisconsin as the primary adult teaching site for MCW, serves a critical role in ensuring the availability medical and social services across the state. It is also trains nearly 1000 nurses and allied health professionals each year.
- As demand for health care increases, medical and scientific advances are needed. At any given time, 2,500 research studies actively take place at Froedtert & MCW.
- Notable research firsts include one of the first interdisciplinary teams in the world to develop functional MRI of the working brain. Survival rates from cardiac arrest are higher in Milwaukee than in other parts of the country in large part because of MCW researchers, whose work formed the basis for health care policies.
- Physicians and researchers at Froedtert & MCW are on the front lines combatting rare diseases and threats to public health. Without this work, these issues could become significant problems for our communities.
- Physicians with a sustained passion for the delivery and application of new treatments seek out the environment of an academic medical center, and this is a direct contributor to the depth and breadth of services provided to the benefit of the community.
- Patients from 15 countries and all 50 states have sought care at our facility, which is often the only local source of specialized capabilities.
Learn more about how an Academic Medical Center benefits the community.