In 2006, with growing numbers of uninsured and underinsured patients, Milwaukee’s health system executives recognized that their organizations individually could not effectively address the systemic issues driving a fragmented, costly healthcare delivery model for this vulnerable population. Emergency department utilization was increasing at all hospitals in the county and almost half of ED visits made by Medicaid or uninsured patients were for primary care treatable conditions. Roughly one-third of Milwaukee county’s adult population was uninsured or covered by government insurance programs for low income individuals, including Medicaid and the county’s General Assistance Medical Program (GAMP). The GAMP program was initiated ten years earlier when the county closed its public hospital and transitioned into a new role as a purchaser, rather than provider, of care for low-income residents ineligible for Medicaid. The GAMP program, based on a distributive model of community clinic and hospital referral relationships, was suffering from chronic underfunding and could not support stable patient-provider relationships. With the economy slowing and area business leaders troubled by studies suggesting that Milwaukee’s healthcare costs were higher than average, health systems leaders realized they would need to be proactive to drive change. It was time, as one CEO said, “to park our competitive juices at the door and have a candid discussion about what we needed to do to fix a broken system.”
For almost a year, the CEOs of the area’s five health systems met privately to discuss the challenges facing the community and the risks of failing to overcome highly competitive instincts. It was clear that building an authentic and sustainable collaboration would require significant, ongoing effort. The Milwaukee community already had a number of initiatives, committees and consortia focusing on different aspects of health care; and the CEOs were cautious about simply declaring a new initiative. Instead, these leaders focused on building an accountable, results-oriented model. Effectiveness would require a limited scope; focusing on health improvement and cost reduction through expanded coverage, access and care coordination for Milwaukee’s vulnerable populations.
Launched in early 2007, the Milwaukee Health Care Partnership has remained true to its mission of improving heath care for the underserved populations by functioning as a convener, catalyst, clearinghouse, broker and advocate for improving health outcomes and reducing total care costs.