MADISON — The Alliance, a Madison-based group of 240 employers, is steering employees to select centers for CT and MRI scans, an expansion of an effort that started two years ago by encouraging workers to get certain surgeries at designated high-quality, low-cost providers.
Gundersen Health System is one of those centers.
Workers who go to the chosen providers for CT and MRI scans, heart bypass surgeries and knee and hip replacements face no out-of-pocket costs as they do for other providers. Some also get cash bonuses and have their travel costs reimbursed through the program, called QualityPath.
“Our aim is to move market share to high-performing physicians and hospitals,” said Cheryl DeMars, president and CEO of the Alliance.
“Health care value is improving way too slowly,” DeMars said. “Through QualityPath, we knit together the new behaviors that are required of providers, employers and consumers.”
The Alliance represents self-insured companies in Wisconsin, Illinois and Iowa covering about 100,000 workers and dependents. Roughly 20,000 of them are insured through the 39 employers participating so far in QualityPath.
The five select providers for CTs and MRIs, beginning Jan. 1, are: Gundersen Health System in La Crosse; Midwest Open MRI in Middleton; OrthoIllinois in Rockford, Illinois; Smart Choice MRI in several eastern Wisconsin cities; and Turville Bay in Madison.
A dozen facilities applied to be part of the group.
The list of surgery providers has changed. Previously, Dr. Vijay Kantamneni at St. Mary’s Hospital in Madison was the designated surgeon for heart bypass surgeries. In 2017, two surgeons at Gundersen, Dr. Venki Paramesh and Dr. Prem Rabindranauth, will be the designated heart bypass surgeons.
St. Clare Hospital in Baraboo and Rockford Memorial Hospital are no longer on the list for knee and hip surgeries. Monroe Clinic remains on the list, with Dr. Lance Sathoff and Dr. Jonathan Swindle, as does UnityPoint Health-Meriter, with Dr. James Bowers.
Sauk Prairie Healthcare was added to the knee and hip surgery list in 2016, with five surgeons: Dr. Matthew Hebert, Dr. Diana Kruse, Dr. Michael Lamson, Dr. David Marcu and Dr. Arnold Rosenthal.
Gundersen is being added to the surgery list in 2017, with Dr. Edward Riley II and Dr. Mark Topolski, as is Beloit Memorial Hospital, with Dr. Leighton Johnson and Dr. Ajmal Matloob.
Employers can save about 20 percent if workers go to the select CT and MRI providers and about 25 percent if they chose the designated surgeons, DeMars said.
So far, 29 surgeries have gone through program and nine surgeries have been avoided by catching incorrect diagnoses or through physical therapy and weight loss, she said.
Valerie Shields, a private duty nurse from Stoughton, had her knee replaced in 2015 by Bowers at Meriter through QualityPath.
Shields, 62, said her knee, which she injured skiing decades ago, became so painful she could barely walk. Another surgeon had said she should get it replaced, but she put off surgery until she learned she could get it, with no out of pocket cost, through her insurance at Webcrafters Inc., a member of the Alliance where her husband works.
Now her knee is “perfect,” and she can run in the backyard with her grandchildren.
“I figured this was an opportunity I may not get again,” she said.