Leaving Fee for Service Behind

In contrast to some physicians, John Toussaint, MD, and his colleagues in northeast Wisconsin don’t mind when the quality of care they provide is measured or even when they are compared to their peers. More than most, Toussaint, previously an internist who now works full-time as CEO of ThedaCare Health System’s Center for Healthcare Value in Appleton, Wis., embraces transparency, and even welcomes having his pay tied to performance, something studies and doctor surveys show remain a worry or even a foreign concept to most physicians across the country. Today, 55 percent of Wisconsin’s physicians report quality information and agree to have it publicly reported on a website for all to see.

But Toussaint and scores of doctors affiliated with ThedaCare and rival Bellin Health in nearby Green Bay have done more than just report whether they have done tests for diabetes and cholesterol. They have turned the results of their treatments into outcome measures that show how care for patients has improved. And now they are even willing to put their pay at risk in the name of quality—an agreement some providers have been leery of in the past.

“Across Wisconsin, we are not just measuring whether the test is done or not, we are reporting whether your blood sugar and cholesterol are under control,” says Christopher Queram, president and CEO of the Wisconsin Collaborative for Healthcare Quality (WCHQ), which is leading the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative in Wisconsin. “This is unique. We are alive and moving into 2014 with momentum and optimism.”

As founding members of the WCHQ, Bellin and ThedaCare have gained national recognition for their efforts to measure, improve, and be paid differently than is predominant for the U.S. health care system across the country. They are helping lead WCHQ’s effort to reform payment across Wisconsin in a way that reduces costs for all consumers, but also expands access to higher quality care for poor patients insured by Medicaid and those with little to no health coverage.