HOW - State Employees
Healthcare of Wisconsin [HOW] is a statutory healthcare payment plan for Wisconsin state employees. HOW, a market-based alternative to a traditional insurance-based plan, purchases healthcare not insurance.
HOW is not a governmental single payer “Medicare for All” plan. HOW is not a self-insurance plan and Wisconsin would not assume the responsibilities customarily assigned to a healthcare insurance company. State employees get the healthcare providers they love and lose the insurance companies they don't.
HOW – Trust Fund
HOW achieves the lowest costs for taxpayers. HOW reduces costs 1) through direct dealing with healthcare providers and 2) by eliminating healthcare insurance companies and pharmacy benefit managers. Instead of paying premiums to healthcare insurance companies, HOW reallocates these taxpayer dollars and establishes a trust fund [FUND] including the requisite initial capitalization and reserves.
The FUND covers the payments to healthcare providers for their goods and services supplied to state employees. The State of Wisconsin Investment Board manages the FUND.
HOW – What Does It Buy
HOW pays for hospitalizations, medical coverage, ambulatory patient, urgency, emergency, pregnancy, maternity, newborn care, mental health, substance abuse disorder, rehabilitative and habilitative care and devices, laboratory, preventative and wellness care, pediatric care, pediatric and adult oral and vision care, medical management programs and prescription drugs.
HOW Network
HOW creates a joint venture network [JVN] of healthcare providers, licensed in Wisconsin. Healthcare providers set their prices for goods and services. They set procedures for referrals, prior authorizations, patients’ appeals, payments, services utilization, etc. They appoint JVN as their agent to negotiate a healthcare-requirements contract with Wisconsin for state employees.
HOW State Agency
HOW creates a state agency governed by a board of trustees, comprised of members from the healthcare industry and Wisconsin ex officio members. This state agency manages HOW operations, processes and pays the claims from the sale of healthcare goods and services to state employees and negotiates with JVN on behalf of state employees.