The Wisconsin Department of Employee Trust Funds (ETF), the largest purchaser of employer coverage in the state, has pursued value for state and local government employees and their families through a number of means, including: public reporting of health plan performance; tiered premiums used to encourage members to purchase more efficient plans; financial rewards to health plans that meet cost and quality benchmarks; an innovative pharmacy benefit management model emphasizing transparency; and a statewide public--private health data repository. Cooperation and dialogue among like-minded stakeholders is very strong in the Wisconsin health care market and has contributed to ETF's success in moderating its costs. One of the challenges ETF now faces is how to shift its value-driven strategies from models that emphasize cost to ones emphasizing quality. The community is also experiencing challenges in minimizing duplication and confusion in its efforts to pursue value in health care purchasing.
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