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BHCG Frequently Asked Questions (FAQs)
For Employers
- What is BHCG and why and when was it formed?
- Who are the members of the BHCG?
- How is quality of care being addressed?
- Who can join BHCG?
- Do I have to use the Humana network to be a BHCG member?
- Isn’t BHCG just for large employers?
- What is the difference between an individual company member and an associate member?
- How are you holding providers accountable for helping to control health care costs?
- What are you doing to expand health care information available to consumers?
- What is the Humana Health Benefit Plan offering designed exclusively for BHCG?
- What are the BHCG health plan benefits?
- How is this different from other health plans?
- What providers are included in Humana Preferred (BHCG)?
- How are providers reviewed for participation in Humana Preferred (BHCG)?
- Are all Humana providers included in Humana Preferred (BHCG)?
- What if a physician is in a group that is not a Humana Preferred (BHCG) participating group?
- How often will Humana make changes? When might providers have an opportunity to join?
- How can physicians be considered for Humana Preferred (BHCG)?
- How do I transition my physician or health care in the middle of treatment for a particular condition?.
- Do BHCG customers have dedicated teams to service the BHCG health benefit plan needs?
What is BHCG and why and
when was it formed?
BHCG, the Business Health Care Group, is a membership organization of large and small employers. It is the business community’s voice and collective action group for influencing the direction of health care costs and quality in our region. The organization was publicly launched in January 2003 to help introduce consumerism into health care decisions and to create a long-term strategy for changing the way health care is used, managed and delivered. The group strives to address the rising health care costs in our region while also ensuring that quality of care and patient health are maintained. More information about BHCG and its mission is available on this site
Who are the members of the
BHCG?
Currently, BHCG represents more than 500 companies throughout Southeast Wisconsin that are responsible for providing health care coverage for more than 165,000 consumers in the region. A complete list of BHCG
members, including companies and coalitions, is available on this site.
How is quality of care being addressed?
BHCG is committed to promoting the evaluation, measurement and sharing of information on health care quality as part of its ongoing support of health care consumerism. BHCG is actively involved in several organizations, including the Wisconsin Purchasers for Healthcare Quality and the Wisconsin Collaborative for Healthcare Quality, both of which spearhead quality of care measurements and information sharing in Wisconsin . Through various quality initiatives, we work closely with providers to improve quality and encourage their commitment to the improvement of health care quality.
Participants in Humana Preferred (BHCG) also benefit from ActiveHealth Management’s industry leading technology which identifies and communicates important care information to physicians and their patients to ensure optimal care is being delivered on a timely basis.
Who can join BHCG?
BHCG is very interested in expanding its membership to other likeminded companies and organizations. Companies of all sizes are eligible to join BHCG, either as individual company members or associate members. Chambers of Commerce and Business Coalitions can join BHCG as sponsoring organizations.
Do I have to use the Humana network to be a BHCG member?
No, but we hope that our members will participate. Using Humana Preferred (BHCG) is an important component of our strategy to move the market in Southeast Wisconsin. We believe that organizing under one administrator is the best way for us to move the market toward a lower health care cost trend. The more employers that use Humana Preferred (BHCG), the more it demonstrates that we are walking in unison and the more the market is likely to respond to our collective influence. If employers don’t organize and behave consistently, then the market will not respond. Reflecting the importance of this approach, member companies with 500 or more employees will lose their voting right if they do not participate in the HPN upon joining.
Isn't BHCG just for large employers?
Several large employers created BHCG in 2002, but the group always intended to expand once the strategy was developed. In the early stages, it was important to limit the size of the group's membership to allow for the active dialogue needed for strategy development. The group's commitment to smaller businesses is evident in the fact that Humana was required to make available a fully insured product using its high performance network. The fully insured products are currently available and coverage will be available for individuals second quarter of 2007.
What is the difference between an individual company member and an associate member?
Individual company members are members who have over 500 employees and that join BHCG independently. Individual company members may participate in all BHCG meetings and activities, and have an individual voting right if they have 500 or more employees and offer the Company’s recommended provider network to their employees. They pay a one-time joining fee as well as the annual per-employee membership fees.
Associate members are members who have under 500 employees and that join independently or through a BHCG sponsoring organization. Associate members do not have a voting right in the Company but will be allowed to access the Company’s recommended provider network and will have access to information, educational materials, and meetings of the Company’s Members determined by the Steering Committee. If an associate member joins through one of the BHCG sponsoring organizations, the sponsoring organization will pay the one-time joining fee for their members, and send a representative to BHCG meetings to vote on their behalf. Associate members who join BHCG through a sponsoring organization pay only the annual, per-employee membership fees.
How are you holding providers accountable for helping to control health care costs?
BHCG asks all parties to be accountable for their role in health care costs. Providers are accountable for quality of the care delivered, complying with medical best practices, for appropriate resource utilization, controlling their cost structures, providing prospective pricing and support for information transparency.
BHCG, through Humana, works closely with providers to measure and report compliance with best medical practices and share information to help them gauge their efficiency. We hold providers accountable to control costs through their individual developed action plans which are monitored for outcome. We encourage all providers to learn more about our approach and to communicate with us as to the needs and improvements they have made in improving health care for the community from both a cost and quality position.
What are you doing to expand health care information available to consumers?
BHCG believes information transparency is an important part of the foundation of the market-driven health care delivery system we are seeking to create in Southeastern Wisconsin. We have worked with Humana to offer health care cost and quality information and also support the efforts to make this type of information available to the public.
Through our partnership with Humana, members enrolled in Humana Preferred (BHCG) will be able to access comparative information for participating providers on their effectiveness and pricing of 31 inpatient procedures based on contractual rates. In addition, 26 outpatient procedure pricing is available based on contractual rates.
BHCG also is supportive of the Wisconsin Health Information Organization, a partnership of health insurers, hospitals, doctors and employers that plans to analyze millions of health insurance claims to find out which doctors and hospitals are the most efficient.
What is the Humana Health Benefit Plan offering designed exclusively for BHCG?
The new plan offering is called Humana Preferred (BHCG). These benefit plans are tied to a high performance network designed to assist consumers in using efficient health care providers. It is similar to other PPO and EPO plans you may be familiar with, but will offer additional benefits that traditional PPO and EPO plans do not offer today.
What are the BHCG health plan benefits?
In addition to exclusive access to Wisconsin ’s first health plan designed to provide consumers with efficient health care providers based on the actual cost of services, BHCG health plan members have:
- A member portal, through MyHumana.com, which will include online tools with efficiency and effectiveness indicators to help health care purchasers make informed decisions about the providers they choose for health care services.
- Access to many of the best-known hospitals and health systems in the area.
- Choice of providers -- Like other PPO health plans, Humana Preferred (BHCG) provides varying levels of benefit coverage for both in-network and out-of-network providers.
- Access to ActiveHealth Management’s industry leading technology which identifies and communicates important care information to physicians and their patients to ensure optimal patient care is being delivered on a timely basis.
How is this different from other health plans?
This is a new approach to health care in the region that asks all involved parties to be accountable for doing their part to control health care costs. To succeed, there must be accountability and partnership with providers, consumers, employers, and the insurance administrator, Humana.
The business community was the driving force in supporting these new, health plan offerings which are designed to control health care cost trend for employers and their employees by promoting consumer engagement, open access to provider price and performance information, and improved efficiency and effectiveness in the delivery of health care services.
What providers are included in Humana Preferred (BHCG), a high performance network?
Find a Humana Preferred (BHCG) provider by zip codeHow are providers reviewed for participation in Humana Preferred (BHCG)?
Physicians identified as efficient in 20 specialties were evaluated by statistical methods, which identified and measured episodes of care costs, including physician, hospital, ancillary, pharmacy, and laboratory costs. There were additional criteria applied to large physician groups.
Not all Humana Preferred (BHCG) physicians were evaluated in the selected specialties or met the evaluation criteria. Some are included because they practice in a physician group practice which as a whole has met the criteria. Other physicians who have not been evaluated or meet the evaluation criteria are included in order to meet geographic access standards or practice in a unique sub-specialty needed in the network.
If a currently contracted Humana provider did not have enough data available to evaluate, the provider was included in the high performance network plan offering; however Humana will continue to track the provider’s data every six months and once a sufficient number of episodes are realized, the provider’s individual performance will be analyzed for continued participation in the high performance network. Physicians who are just starting their participation with Humana (never have been contracted with Humana as a provider) will be included in other Humana networks and products, except for the high performance network for a minimum of one year, allowing time for the provider to gain sufficient practice data to be analyzed based on Humana’s episode of care methodology.Are all Humana providers included in Humana Preferred (BHCG)?
Not all Humana contracted physicians are included in Humana Preferred (BHCG). However, all types of providers are included in the Humana Preferred (BHCG) plan offering to ensure comprehensive care delivery by network providers.
What if my physician is in a group that is not a Humana Preferred (BHCG) participating group?
Individual physicians who are part of physician groups participating in Humana Preferred (BHCG) are always included if the group is included. Likewise, individual physicians who are with a group that is a nonparticipating group, are not participating if the group is not participating.
How often will Humana make changes? When might providers have an opportunity to join?
Humana will make changes on an annual basis if necessary. Provider participation is based on Humana's selection process.
How can physicians be considered for Humana Preferred (BHCG)?
If a physician is not currently a participating provider with Humana, they can call Humana’s Provider Relations Department (800) 626-2741 for more information. Note: Physicians who are currently Humana contracted physicians not currently included in the Humana Preferred (BHCG) plan offering will be evaluated annually for possible participation.
How do I transition my physician or health care in the middle of treatment for a particular condition?
This would be handled the same way it is handled today by an employer who makes a change in health plan benefits or health plan carriers from one plan year to the next. There are transition-of-care regulatory processes each company administers for employees who have transition of care situations.
Do BHCG customers have dedicated teams to service the BHCG health benefit plan needs?
Yes, BHCG customers are serviced by a Humana dedicated team of specially trained billing, enrollment, claims and customer service representatives along with a dedicated 800 number focused exclusively on Humana Preferred (BHCG) health plan members.
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