MILWAUKEE, Wis.—Feb. 16, 2018—A WPS executive recently participated in the Milwaukee Business Journal's Health Care CEO Roundtable.
Scott Kowalski, Executive Vice President of WPS Health Insurance, was the only health insurance expert on the panel, which included representatives from health care provider organizations, and medical and nursing schools, among others.
In his remarks, Kowalski noted that it's increasingly difficult for health insurers to get close to their customers to manage chronic conditions. Since the implementation of the Affordable Care Act (ACA), individual customers have been more transient. Also, there's a trend for group insurance clients to shop around every year for better pricing. The result, in both cases, is high turnover of patients. This lack of continuity contributes to a perception that people don't want to be managed by their insurance company, he said.
Kowalski also noted that the increasing sophistication in health care is causing health insurers like WPS to engage medical consultants with specific areas of expertise. These consultants are being used to evaluate authorization requests and claims for such things as high-end oncology drugs, advanced diagnostic imaging (like 3-D mammography), and mental health treatments.
In its Feb. 16 edition, the Milwaukee Business Journal included two articles based on the roundtable discussion.
Panelists discussed the Wisconsin governor's proposal to stabilize the individual health insurance marketplace.
In one of the articles, Kowalski said he is hopeful the proposal will allow Wisconsin to revive the Health Insurance Risk Sharing Plan of Wisconsin (HIRSP) that provided coverage to those who were considered too high risk to cover. The ACA precluded insurers from denying coverage based on pre-existing conditions.
"We may be able to bring that back and serve as a model for the country again."
Scott Kowalski, Executive Vice President of WPS Health Insurance
