Wisconsin Collaborative for Health Care Quality

Program Location: 
Madison, WI
Payer Type: 
Grant
Description: 

Partnership for Healthcare Payment Reform has developed a Chronic Care Pilot Program to provide a continuum of quality care and address a number of flaws in current payment structures for the treatment of adult diabetes. These flaws include:

  • failing to pay for necessary services while not discouraging unnecessary ones
  • lack of coordination across multiple providers
  • lack of incentives to promote preventive strategies and high quality care.  

PHPR's Chronic Care Pilot program will provide better and more affordable care and will help promote healthy people and communities. Using payment reform as both a catalyst and key strategy, this project will foster:

  • better management of care
  • reduction of avoidable complications
  • more efficient care supported by investment of shared savings returns as well as the flexibility of a risk-adjusted global case rate
  • changes in physician compensation systems to better align with value
  • strategic redesign of health care benefit plans
  • enhanced community engagement around diabetes prevention.
Payment Model: 

Shared savings model for Years 1 - 3:

  • Providers take clinical risk, insurers take insurance risk
  • During shared savings phase, providers eligible for 75% of shared savings amount depending upon quality measures; payers retain 25%

Plan design changes implemented in Year 2 and beyond Year 4 and beyond:

  • Transition to total episode of care payment
  • Multi-payer pilot (each provider will work with several commercial payers) 
Last updated September 2018
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