BBJ October/November 2012

GREEN BAY’S SUPERIOR BUSINESS MAGAZINE FOR MORE THAN A DECADE

Published by the Green Bay Area Chamber of Commerce for Chamber members

B A Y B U S I N E S S J O U R N A L

October/ November 2012VOL 20 #5

about the newhealth care law?Get different experts' insiGhts inside

Make your event historical.Create your own moments of glory.

Call the Lambeau Field Special Events Team today!

920.569.7515Lambeaufi eld.com

Celebrations.Memories.

Connections.

Dreams.

weddings • trade shows • corporate luncheons anniversary parties • cocktail receptions • meetingsweddings • trade shows • corporate luncheons anniversary parties • cocktail receptions • meetings

Lambeau Field is the ideal place to hold special events. Accommodating and inviting, all guests will be assured a legendary experience. Includes exquisite catering and a championship staff. Group sizes available: 5 to 1500

© Green Bay Packers, Inc.

AtriumAd_BayBusinessJrnl.indd 1 5/3/10 1:15 PM

Make your event historical.Create your own moments of glory.

Call the Lambeau Field Special Events Team today!

920.569.7515Lambeaufi eld.com

Celebrations.Memories.

Connections.

Dreams.

weddings • trade shows • corporate luncheons anniversary parties • cocktail receptions • meetingsweddings • trade shows • corporate luncheons anniversary parties • cocktail receptions • meetings

Lambeau Field is the ideal place to hold special events. Accommodating and inviting, all guests will be assured a legendary experience. Includes exquisite catering and a championship staff. Group sizes available: 5 to 1500

© Green Bay Packers, Inc.

AtriumAd_BayBusinessJrnl.indd 1 5/3/10 1:15 PM

Book your event at Green Bay Botanical Garden

Whether it’s during WPS Garden of Lights or any other time of year, the Donald & Patricia Schneider Education Center has a variety of spaces available and is an impressive setting for:

Holiday Dinner & Cocktail Parties Meetings Lectures Classes Small Conferences

Each space is fi lled with natural light and features views overlooking the Garden. Plan a beautiful event or meeting with a memorable setting for any occasion.

For more information contact the Sales and Rental Coordinator at (920) 491-3691 ext. 113 or [email protected]

Beauty for all Seasons at the Garden

Rental Space is available for Holiday Parties.

2 | BBJ JUNE/JULY 12

14 Global Locations

www.megtec.com • [email protected]

MEGTEC Systems, Inc.…proud to be an employer in Brown County for over 40 years, providing innovative solutions for our customers involved in:

MEGTEC’s global headquarters is located in a 365,000 sq. ft. facility in De Pere, Wisconsin, and is a center for excellence in Engineering, Manufacturing and Service.

Advanced Materials Processing

Environment, Climate & Energy

Printing & Packaging Applications

Make sure your insurance plan includes Children’s Hospital of Wisconsin• Pediatric specialists and subspecialists from allergy to urology.• Fox Valley’s top-level intensive care nursery.• The only hospital in the region that treats children exclusively

and has pediatricians on site 24/7.• Inpatient care, specialty care and neonatal intensive care in the Fox Valley.

It’s easy to see why Children’s Hospital of Wisconsin means the best care for kids. And just in case your child ever needs more, we’re your connection to Children’s in Milwaukee, rated one of the best in the nation.

130 Second St., Neenah(920) 969-7900

Every child. Every need. Every day.

chw.org/foxvalley

120015

C R

FEATURES

08 Patient Protection and affordable care act Making heads or tails of what its 2,400 pages mean for

your business

17 the continuing Politics of healthcare reform November elections could result in repeal or amendment of

parts of the Affordable Care Act

22 aurora baycare medical center Local healthcare entity is an instrumental teaching hospital

and clinical trial conductor

BBJ DEPARTMENTS

04 VieW Point

06 tech Watch

24 business sPotlight

26 booK reVieW

28 meet a member

30 chamber briefs

32 chamber neWs

ADVERTISERS

01 LAU NCH FI LM.com 02 M EGTEC Back Cover Cel lcom01 Green Bay Botanical Garden Ins ide Back Cover TDS07 Express Convenience Centers 21 Network Heal th Plan07 Univers i ty of Wisconsin Oshkosh Col lege of Business 02 Chi ldren’s Hospi ta l of Wisconsin 19 Kel ler Inc. 25 MetJet Ins ide Front Cover Lambeau Fie ld

The BBJ is published bimonthly by the Green Bay Area Chamber of Commerce, PO Box 1660, Green Bay, WI 54305-1660. The BBJ is supported entirely by advertising revenue from member companies of the Green Bay Area Chamber of Commerce. For information about the advertising rates and deadlines, contact Sales at 920.593.3404. The BBJ (USPS 010-206) is published bimonthly for $18 a year by the Green Bay Area Chamber of Commerce, PO Box 1660, Green Bay, WI 54305-1660. Periodicals postage paid at Green Bay, WI. Postmaster: Send address changes to The BBJ, P.O. Box 1660, Green Bay, WI 54305-1660. Ph: 920.593.3423.

Copyright© 2008 Green Bay Area Chamber of Commerce

PRESIDENT Laurie Radke EDITOR Lori Kaye Lodes GRAPHIC DESIGNER Dana Jacobson

VISIT THE GREEN BAY AREA CHAMBER OF COMMERCE AT:

titletown.org

contents.Volume 20, #5 | October/November 2012

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12345VIEW POINT

TEXT laurie radKe

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As mentioned in my last “Viewpoint”, the Chamber has established five strategic initiatives for the 2012-2013 fiscal year, which we launched Sept. 1. These were months in the making, and they reflect the core of the Chamber’s direction as we enter this new year. The overarching question we asked in creating these was, how can we as an organization be ef-ficiently organized to execute the value members are looking for?

Lead through coLLaboration. We will strategically collaborate and connect our members to become the preferred partner of area businesses, local governments, community organizations and educational in-stitutions supporting economic, workforce and community development.

When we posed that question above, this answer appeared first and foremost. We know we need to be good stewards of resources both internally and externally when we work with partner businesses. We know we are not in the business of being “everything to everyone.” However, we do want to be that point of connectivity for businesses seeking information and resources. To accomplish that, we need to partner with and communicate with other community resources that run parallel to us in terms of striving to accomplish similar goals; they just do so through different means. This brings to mind organizations including the Greater Green Bay Community Foundation, Bay Area Community Council and United Way of Brown County. Internally, we further this collaboration with various boards of directors; our Advance board of directors is composed of both municipal representatives and business leaders. Our Partners in Education board of directors is com-posed of K-12, CESA 7 and postsecondary education representatives and business leaders.

buiLd economic prosperity. We will focus on developing entrepreneurialism, assisting existing businesses and pursuing targeted initiatives that foster an innovative business environment and strengthen our community’s economy.

One of the pillars on which the Chamber is built is economic develop-ment. As an organization rooted in businesses’ livelihood, we need to be focused on economic development. The Chamber has a division – Advance – that spearheads economic development countywide. And it does a stellar job of it. Based on 884 program participants 2011-2012, Advance estimates its total economic impact at more than $55 million! The Advance Business & Manufacturing Center incubator is at its highest occupancy levels (68 percent) since it moved to its cur-rent facility; 98 percent of available office space is occupied, and 50 percent of our light industrial space is filled. And the recently cre-ated Brown County Culinary Kitchen incubator, of which Advance is one partner, has also exceeded initial planning parameters with 13 licensed tenants. We’re also pleased to announce that our Advance Microloan program was recently certified by the Small Business Administration (SBA) as an intermediary microloan lender and received $500,000 in funding from the SBA.

But we don’t believe economic development efforts should be confined to one area or program. The expectation is that every program in the Chamber will plug into our Chamber wide economic develop-ment initiatives as we create or modify our programming and offerings. Everyone owns this effort.

how we deLiver vaLue – 5 strategic objectives

BBJ OctObEr/NOvEmbEr 12 | 5

be the voice of business. We will influence issues of public policy that are crucial to building a prosperous business environment.

The first thing that often comes to mind with the idea of being a voice for business is the efforts of our Public Policy Council and Good Gov-ernment Council. Our government affairs area at the Chamber, which houses these two groups, is focused on business issues that make their way into legislation. But being the voice of business also entails serving in an educational role to our members, creating white papers on policy issues of significance to business (two are underway right now) and offering learning opportunities specifically geared to small- and medium-size businesses including our “Let’s Wrap” series that launched its first session on Sept. 17 with a focus on top line labor issues. In addition, we establish a legislative agenda every two years that is business policy driven. We’re also in the process of revitalizing our grass-roots advocacy efforts with VoterVoice. This technology-based system lets us alert members to particular issues, match them with their correct elected officials and guide them in their message sending process to legislators if you want to make your voice heard.

In addition, the Chamber is a long-standing member of the Northeast Wisconsin Chamber Coalition (NEWCC), which has four Chamber partners that work collaboratively to create a regional voice for busi-ness as we work with legislators.

enhance quaLity of Life. We will mobilize our membership and resources to improve workforce and community development in ways that will en-hance quality of life in the green bay area. We will have a primary focus on leadership development to produce strong, engaged business and community leaders.

The Chamber has made a very concerted effort – and continues on that path – to enhance quality of life in the Greater Green Bay area. Among the most prominent of these efforts include funding the LIFE (leading indicators for excellence) Study, a very in-depth analysis of 10 key areas that have a direct and strong effect on how people rate the quality of life in Brown County. We followed this with the Brown County 20/20 Visioning Summit coordinated by the Bay Area Com-munity Council (BACC), an effort that brought together a think tank of some of the most innovative, informed and creative minds in the area to address gaps and issues in the community. Quality of life is something high on our radar because keeping existing businesses here, and attracting new ones, is largely about the quality of life an area offers in terms of everything from education to volunteerism, arts and culture to recreation and leisure and, of course, the educational system and workforce development. It’s also what prompted us to bring the LIVE54218 initiative under the Chamber’s umbrella; to fos-ter workforce development and economic success, we know creating a healthy community is vital.

Quality of life is also rooted in professional development, and the Chamber offers a multitude of opportunities for that including our Brown County Teen Leadership program (which has expanded its session days and participant numbers), Current young professionals group (which is now at nearly 1,000 individual members and continu-ing to grow) and the Chamber’s diversity efforts to be more inclusive of businesses owned by women, veterans and various minorities.

strive for organizationaL exceLLence. We will engage our members, empower our employees and maximize our resources in a fiscally responsible manner to build an innovative organization aligned with our mission and vision.

To us, striving for organizational excellence is a group effort. That’s why you’ll see more of the Chamber engaging you, our members, whether it’s participating in committees or simply offering input. We know members are the bloodline of this organization, and that “growth demands participation.” Nothing could be truer; as with many things in life, you get out of it what you put into it. That’s why we offer – and will continue to offer – a variety of increasingly relevant events, services and programs. Business doesn’t operate in a vacuum, and neither can the Chamber.

But we can’t ensure they remain relevant without your input. To this end, we’re also working on adopting a continuous improvement model so we are always getting – and incorporating – feedback. We want to always live up to your expectations to be flexible, adaptable and fiscally responsible.

Make sure you're in the loop. sign up to receive any/all of the chamber's free e-newsletters at

titletown.orG.

are you in the know?


TECH WATCHTEXT al Pahl

Home offices, small offices and individuals have a new web-based email option. Not only is it free, but it comes with some web apps built in.

They are also free. And you may have heard of them: Microsoft Word, Microsoft Excel and Microsoft PowerPoint.

In fact, you’ve heard of the basic email product, too – Outlook. This version is called Outlook.com. It’s engineered and hosted by Microsoft, which touts this product – clearly aimed at Google’s Gmail – as innovative, convenient and easy to use, whether you are in the office or on the road; via desktop, laptop, tablet or smartphone.

Did we mention it is free?

One of the coolest innovations is Outlook.com automatically categorizes your email for you. The idea being: You will not miss an important email, which might otherwise be lost in the undergrowth of your inbox. You can go with Microsoft’s setup or create your own. Either way, you have virtual folders in your account, and Outlook will automatically move emails into the proper folder. This obviously reduces clutter in your email box, which will free more visual space for important emails. Or, you simply find your important emails in those folders to which you directed Outlook.com to automatically move them. So, the bad stuff gets moved out, and if you plan it this way, all the emails concerning your big new project are sorted into your “big new project” folder.

Remember: This is done by an algorithm. So, certainly, there will be fits and starts as you refine your processes. Microsoft has tried to streamline the system of setting up your own inbox rules. Bloggers and reviewers wrote positively about this feature.

The automatic folder setup will also help users who access their email frequently from their smartphones. Microsoft studies show

mobile users don’t do as much mail management as computer us-ers. Redmond designers see the automatic folder feature as a way of helping those users in particular to organize and prioritize their inboxes in a way that can work in virtually any type of desktop or mobile email client. Microsoft expects mobile users to use their prod-ucts’ native mail clients and thus it set up Outlook.com to interact with virtually any of them. It sounds like Microsoft is focused on de-livering an excellent mobile web experience.

Have you noticed Google’s Gmail actually mines the contents of your emails, in order to serve you targeted ads? Suppose you’re emailing back and forth with your brother, who is trying to troubleshoot a wir-ing problem on his car. Gmail serves you auto-related ads. That’s one thing. Now, suppose you’ve got an email chain going with your sis-ter, who believes your father is addicted to his pain medication and the question under discussion is what to do next. Isn’t it just a little creepy that Gmail now serves you ads related to addiction-treatment services and the like?

Google, of course, will tell you it’s the price you pay for unlimited storage and a free service. You know the trade-offs up-front. On the other hand, advertising in Outlook.com appears only in your main menus, not while you are actually reading an email. Microsoft prom-ises it will not text-mine your inbox, while still offering its service for free, and with “virtually unlimited” storage.

Naturally, Microsoft stores your email in the cloud, in its SkyDrive service. Users get 7 GB of free storage space, which, Redmond estimates, is enough for 20,000 Office documents or 7,000 photos. Instead of running into size limits for email attachments, users can email a link of any of their photos or Office files. Recipients can see photos and docs, even if they don’t have Office on their computer.

In fact, neither you nor your e-mail recipient need to have Office installed to be able to open, edit and share Office files right from your inbox. And, your formatting changes will stay intact, Microsoft claims.

outLook.com offers access to web apps of microsoft software & emaiL organization


Designing in gracious photo sharing is just the tip of integration at Outlook.com, which gives users easy access to Facebook, Twitter and LinkedIn. When you read an email from me, the right column of your message screen will show my LinkedIn contact information and my latest status updates. You can also respond to status updates on Twitter, write on someone’s Facebook wall or do Facebook chat; all directly from Outlook.com. There is also integrated instant messaging – some-thing a small business can actually use for work purposes.

Let’s review: Outlook.com is free. The system helps reduce clutter and otherwise organize your inbox, which is accessible from pretty much any connected device. Word, Excel and PowerPoint web apps are built in, for free. You get 7 GB of cloud storage on SkyDrive, which makes sharing photos, videos or those large business-related files easy, by doing away with huge attachments. If you’re look-ing for a new personal email system or you’re too small of a business to take advantage of having your own Microsoft Exchange server, Outlook.com is worth a look.

Thinking about getting your MBA? Learn about UW Oshkosh’s accredited part-time Professional MBA and Saturday Executive MBA.

Oct. 17 WausauOct. 23 Stevens PointOct. 29 SheboyganNov. 6 Fond du Lac

Each info session will begin at 6 p.m. To register for an information session, call 920-424-3199 or toll-free 800-633-1430 or visit uwosh.edu/go/mba.

Nov. 13 OshkoshNov. 14 AppletonNov. 19 Green Bay

Holly Brenner,BBA ‘98, MBA ‘09Director of Marketing& Business DevelopmentAgnesian HealthCare,Fond du Lac

...whereprofessionalsemerge as

leaders.


Key pieces of the lawFor small businesses and entrepreneurs, there are a number of items in the new health care law that could be the difference be-tween receiving the benefits of the law or paying in. The number of employees a business hires is critical. Companies with 50 or more full-time employees are required to provide “minimum essential” and “affordable” coverage to employees, or face fees – $2,000 per em-ployee who averages 30 hours or more per week, excluding the first 30.

Every individual, including sole proprietors, are required to have health coverage, or pay a tax. The tax will be $95 for 2014, $325 for 2015 and $695 for 2016 (or 2.5 percent of income, which-ever is greater.) Individuals exempt from this tax includes those on Medicaid or Medicare, incarcerated, illegal aliens, or members of an Indian tribe or religions who are opposed to accepting benefits. For individuals with annual premiums that exceed 8 percent of their household income, a “hardship exemption” may apply. These same individuals are all qualified to get coverage under the new health insurance exchanges.

Small businesses that have had a health plan in place before March 23, 2010, are allowed to keep the plan. These “grandfathered” plans are subject to fewer requirements under the new health care law.

Jennifer hogeland TEXT submitted PHOTOGRAPHY

8

The U.S. Supreme Court’s decision on June 28, 2012, to uphold Presi-dent Barack Obama’s Patient Protection and Affordable Care Act has forced many individuals, employees, employers and businesses to take a closer look at how the legislation will impact them.

The lengthy health care reform document, which was signed into law in March 2010, has several objectives – improving access to health care and lowering health care costs – but the upcoming changes and unknown costs are causing anxiety among many.

“This has been a highly polarizing and anxiety producing legislation,” says Kelly Kuglitsch, employee benefits attorney for Davis & Kuelthau. “The uncertainty over how the new law will operate when it is fully implemented has caused the greatest concern.”

While the focus is on improving access and the quality of health care and reining in the ever-increasing cost of care, Kuglitsch explains the third purpose of creating the Affordable Care Act is to find a way to pay for the enacted reforms. “A matter of broad agreement surround-ing the health care reform debate that resulted in the legislation was that any enacted reforms should be accompanied by enough tax in-creases and other revenue raisers to have a net positive effect on the federal budget,” she says. “In the law, as enacted, many of the savings will come from provisions in the law to address Medicare and other health care fraud, waste and abuse.”

The law is currently designed to increase several specific taxes and impose an assortment of fees and penalties on individuals, employers and other stakeholders in the health care system.

overview of the Patient Protection and Affordable Care Act

COVER STORY


reform already in placeThe health care reform is being rolled out in phases. Over the last two and a half years, parts of the legislation have been implemented. Of the programs rolled out to date, one of the most popular reform laws extended dependent coverage for adult children of a health care par-ticipant up to age 26.

“Employers are required to offer that coverage to dependent children up to age 26, regardless of any factors other than the dependent’s relationship with the employee and his or her age,” says Todd Cleary, attorney for Godfrey Kahn.

Also in place, insurance companies are prohibited from imposing pre-existing conditions for individuals under age 19.

Insurance companies may no longer impose lifetime dollar limits on how much the plan will spend on an individual.

New health plans must provide preventive care. Cleary adds, “Non-grandfathered health plans now have to pay dollar one for preventive care. They can’t impose copayments or deductibles on certain preven-tative care procedures.”

A tax credit is now available to certain small employers to help pay for the cost of health insurance. Kuglitsch adds, “Businesses with 25 or fewer employees are currently eligible to apply for a credit of the amount they are paying for their employees’ health insurance costs. It uses a sliding scale – the very smallest employer, in this case 10, will get the largest payment. It is a very unused part of the health care law because a lot of small businesses aren’t familiar with the law or they feel it is too hard to access.”

Kuglitsch shares another program already in place is a provision per-mitting employers with 100 or fewer employees to adopt a simple cafeteria plan. She says, “It is a streamlined, more simplified way to offer a flexible savings account and dependent care option that does not have to satisfy as many of the non-discrimination rules that normal cafeteria plans do. It expands the realm of feasible benefit options for smaller employers.”

An increase in the penalty tax will be imposed when taking a with-drawal from a health care savings account that is not used to pay for qualifying medical expenses. “In the past, that excise tax amount was 10 percent,” adds Kuglitsch. “Effective Jan. 1, 2011, it is now a 20 percent tax if you take money out of a health savings account for non-qualifying health costs.”

Medical loss ratio requirements are already in effect. Insurance com-panies have to disclose what they are spending their money on and limit their administrative costs and profits. Kuglitsch says, “Many health plan participants may have already received a rebate from their insurer to the extent the insurer spent more than they should under the new laws on the actual coverage as opposed to health care costs.”

Above are among the early changes implemented to comply with the reform legislation. Cleary explains that for the most part, these items required less planning from an employer’s perspective, and they seem to be more politically palatable for the nation.

going into effect nowCleary explains the biggest thing on the short-term horizon is the no-tice requirement called the Summary of Benefits and Coverage. Em-ployers must describe the health plan’s benefits and coverage rules in a standard format issued by regulators. This requirement is in effect for enrollments that occur on or after Sept. 23, 2012.

Starting with plan years ending after Sept. 30, 2012, there is going to be a new Patient-Centered Outcomes Research Fee imposed on employer plans based on the plan’s covered lives. The fee will be $1 per covered life times the average number of covered lives for the first year; $2 per person for plan years ending Sept. 30, 2013.

Jan. 1, 2013, is another looming deadline with changes in flexible spending accounts. Health care flexible spending accounts will have a new cap on annual elections. Individual participants can only elect to put away $2,500 per year to later be reimbursed for copays or certain prescription drugs.

If an employer offers a wellness plan through which participants receive an award or pay a surcharge based on a health standard, Kuglitsch shares the current law limits that amount to 20 percent of the total cost of their health insurance premium. On Jan.1, 2013, that will be raised to 30 percent.

“I think that is the only health care reform change that is universally applauded by employers,” says Cleary. “I think employers felt they were restricted by the 20 percent limit because it didn’t provide enough of a carrot to incentify employees to change their behavior.”

By Jan. 31, 2013, all employers need to report the cost of the em-ployer sponsored health care coverage on their employees’ 2012 W-2 forms.

effective Jan. 1, 2014Much of the anticipation of Jan. 1, 2014, is caused by the expected implementation of the shared responsibility payments legislation. This applies to individuals through individual mandates and to employers through the mandate to offer coverage to employees. If individuals don’t have health care coverage or employers don’t offer coverage to their employees, there will be a penalty to pay. “This is the idea that the increased coverage for everyone is only going to be affordable if all are covered – the healthy and unhealthy,” says Kuglitsch.

Beginning in 2014, if an individual, his/her spouse or their dependents lack minimum essential coverage, then they will be assessed a shared responsibility penalty. The shared responsibility penalty for individuals who chose not to have coverage is the greater of two amounts – a flat dollar amount or a percentage of income amount.


Kuglitsch explains the flat dollar amount is a set per-person amount that changes over the next three years. The fee is $95 in 2014, $325 in 2015 and $695 for 2016 and thereafter. If the amount applies to individuals 18 or younger, the fee is half of the yearly penalty.

The percentage of income amount is determined by looking at the taxpayer’s household income, minus certain deductions and multiplied by an applicable percentage. The percentage is 1 percent for 2014, 2 percent for 2015 and 2.5 percent thereafter. Some observers fear the low fee for passing on coverage will inspire the young and healthy to opt out of health care plans.

The employer mandate is meant to help ensure all people have the op-tion of coverage. Kuglitsch says beginning in 2014, employers with 50 or more employees may be subject to a penalty tax, called an acces-sible payment, for failing to offer coverage to all full-time employees and their dependents. Cleary says, “The employer only has to provide minimum essential coverage to full-time employees, which is generally employees working 30 or more hours a week.”

Kuglitsch adds, “The coverage that they would be required to offer to avoid the penalty is called the minimal essential coverage with details yet to be defined by Health and Human Services.” A large employer’s plan must also cover at least 60 percent of health care expenses.

It is permissible for an employer not to offer coverage, but the penalty will be $2,000 per employee, minus the first 30 employees. Kuglitsch explains, “If an employer had 50 employees, they would pay for 20 employees times $2,000 so the minimum penalty would be $40,000 per business.”

If an employer does offer coverage but it falls within the definition of being unaffordable, costing employees 9.5 percent or more of their gross W-2 pay, then the cost of the plan is deemed unaffordable and the employer must pay $3,000 per full-time employee minus the first 30 employees. “The intention of subtracting the 30 is to limit the total impact that penalty may have on a business,” adds Kuglitsch.

Observers fear employers will opt out and pay the penalty instead of providing coverage because they will conclude it is a better finan-cial decision, although Cleary hasn’t heard that anecdotally. He says, “There are a lot of factors at stake. The math is more complicated than originally thought, and there are non-mathematical factors to consider including taxes and employee expectations.”

Also taking effect are the health insurance exchanges. These must be operational by Jan. 1, 2014, to coincide with the mandates. The official name of these exchanges is American Health Benefits Ex-changes. They are intended to pool participants to create larger risk pools, which will result in bargaining power with providers and insur-ance companies. This will assist individuals and employers in obtaining or providing the required minimum health benefit coverage.

“The primary function of the exchange is to make qualified health plans available to qualified individuals and employers,” says Kuglitsch.

Kuglitsch explains health insurance issuers offering coverage in the individual or small group market through state-based exchanges must provide an essential health benefits package. Categories of benefits within the essential health benefits package include ambulatory pa-tient services, emergency services, hospitalization, maternity and new-born care, prescription drugs and more, but she explains until further guidance is issued by Health and Human Services, there is no way to determine precisely which benefits will be considered essential or what cost sharing limitations may apply.

The legislation states each state is required to establish its own exchange. “The exchange can either be a governmental en-tity that is set up in the state or a nonprofit entity set up in the state,” adds Kuglitsch.

If a state doesn’t establish an exchange, or show signs of suffi-cient progress in establishing an exchange, by Jan. 1, 2013, the Health and Human Services de-partment is required to establish and operate an exchange with non-participating or non-compli-ant states. Kuglitsch says, “That is of particular concern for Wiscon-sin – many are curious what will happen because we are getting close to 2013 and our exchange hasn’t been established.”

“I think if an employer is going to drop health care coverage in 2014, they need to advise their employees well in advance.” — Todd Cleary, attorney, Godfrey Kahn

Kelly Kuglitsch, employee benefits attorney, Davis & Kuelthau

Todd Cleary, attorney, Godfrey Kahn


A required part of the exchange that doesn’t get as much buzz is the Small Business Health Options Program, or SHOP. This is a separate service that is required to be offered by the state with the intent to assist small businesses in providing sufficient coverage for their em-ployees. SHOP plans will use economies of scale when setting rates that until now were only available to large employers.

“Each state is required to establish and operate a SHOP,” adds Kuglitsch. “The SHOP exchange can be independent of the other American Health Benefits Exchange for individuals or it can be merged if there are adequate resources to service both individuals and employers under that exchange.”

SHOP will originally be available for employers with 100 or fewer employees, but on Jan. 1, 2017, all employers will be invited to partici-pate in the SHOP exchanges.

Businesses with fewer than 25 full-time employees get a Small Em-ployer Health Insurance Credit. According to www.IRS.com, for tax years 2010 through 2013, the maximum credit is 35 percent for small business employers and 25 percent for small tax-exempt employers such as charities. An enhanced version of the credit will be effective beginning Jan. 1, 2014, and the rate is expected to increase to 50 percent and 35 percent, respectively.

On Jan. 1, 2014, there will no longer be an annual limit imposed on the essential health benefits. “Currently a lifetime limit is prohibited, but by 2014 there is no longer an annual limit,” says Cleary.

Excessive waiting periods for joining a health plan will no longer be allowed.

Cleary says those with individual coverage will not be discriminated against based on their health status. He says, “Under the current law that is already in effect for employer-provided insurance, it is prohib-ited through employer plans with HIPAA rules, but that hasn’t been the case in the individual market. If you had pre-existing health conditions you could either pay much higher premiums or you would be denied altogether.” In 2014 the individual market will be designed to be more like the group market.

“The one common theme I see is this health care reform law will change the paradigm from everyone obtaining health care insurance through an employer to moving away from the employer-provided coverage system because there will now be the option to get health insurance coverage elsewhere,” says Kuglitsch.

reactions to the legislationThe response to the legislation has certainly been mixed. The indi-vidual mandate was such a source of contention that it went before the Supreme Court.

Employers fear how it will impact their finances. “There is lots of con-cern over the costs that will be imposed on employers, but there is also relief expressed by individuals who understand it is going to be a lot easier and more affordable to obtain coverage, especially in circum-stances where it wasn’t easy to obtain previously,” says Kuglitsch.

Cleary adds, “Many employers are unhappy about the extra adminis-tration and extra burden on their human resource people, but some small employers may be happy they have more opportunities available to them now.”

The requirement to have health exchanges operational by Jan. 1, 2014, has also been controversial. Kuglitsch explains the Doyle administration moved quickly to implement the exchange for Wiscon-sin, but Governor Walker joined the lawsuit to oppose the health care reform. She says, “He’s not implementing the health care exchange, and it’s not clear how that is going to impact the setup of exchanges in Wisconsin.”

Preparing for looming deadlinesIn light of the Supreme Court ruling, Kuglitsch urges employers who have taken the “wait and see” approach to move ahead, either to begin or to continue preparations for health care reform. “Given the variety of sources for health care coverage that will be available – employer coverage, individual coverage through exchanges, employer offered coverage through SHOPs – the optimal solutions for any given com-pany will vary,” she says.

In the very short term, Cleary suggests employers have a handle on the Summary of Benefits and Coverage and the W-2 requirements. “Look at your arrangement if you have a non-grandfathered insured plan to make sure it complies with the non-discrimination rules when the government agencies issue guidance because the downside is so big,” he adds.

“I’m recommending all small employers, those with 25 or fewer em-ployees, assess their eligibility for the small employer tax credit if they haven’t already done so,” says Kuglitsch.

The final thing for employers to do is project where they stand in the “pay or play” scenario. “I think if an employer is going to drop health care coverage in 2014, they need to advise their employees well in advance,” adds Cleary.

“The one common theme I see is this health care reform law will change the paradigm from everyone obtaining health care insurance through an employer to moving away from the employer-provided coverage system because there will now be the option to get health insurance coverage elsewhere.” — Kelly Kuglitsch, employee benefits attorney,Davis & Kuelthau


health care providers respond to legislation

12

reaction to medicaid changes and creation of exchanges“The legislation is designed to make sure that more and more people in the country have some level of health coverage so the large number of uninsured in the country comes down,” says George Kerwin, president and CEO of Bellin Health.

Wisconsin is unlike many states across the country in terms of the breadth and depth of Medicaid coverage. Jim Dietsche, executive vice president and chief financial officer for Bellin Health, adds, “The state has been innovative in finding ways to cover more individuals that don’t have other means of health care coverage through our Medicaid pro-grams, specifically BadgerCare.”

“We have been at about 95 percent coverage, which was the goal of the Affordable Care Act. The Act actually put a floor of 133 percent of the federal poverty level; Wisconsin was at 200 percent or higher for cer-tain populations for coverage under Medicaid,” adds Heidi Selberg, vice president, strategy and advocacy at HSHS Eastern Wisconsin Division.

The Supreme Court ruling in June allowed Medicaid ex-pansion to stand but stated the government couldn’t force states to expand cov-erage or lose their existing federal funding. The respon-sibility was put back on the states to develop mecha-nisms to increase the num-ber of insured.

Selberg explains this raised all sorts of questions from health care providers. Will Wisconsin roll back eligibility to 133 percent and work with the remaining populations to go through the exchanges? Since Wisconsin wasn’t able to cover all eligible childless adults, will they be consid-ered to be newly insured un-der Medicaid? Can individu-als or families get subsidies

Jennifer hogeland TEXT submitted PHOTOGRAPHY

Amid the wonder and worry about how the Affordable Care Act legisla-tion will play out in Wisconsin, area health care providers feel they’ve already been heading in the right direction.

“Wisconsin has highly integrated health delivery systems, which is un-usual compared to the rest of the nation. Many of the state’s hospitals are already performing at a high level in terms of quality and cost,” says Therese Pandl, president and CEO of HSHS Eastern Wisconsin Divi-sion. “It is this high quality that makes it an advantage for Wisconsin businesses and communities.”

The purpose behind the Affordable Care Act is to improve the quality and value of health care. Pandl adds, “The state has been very transpar-ent and has a long history of commitment on improving quality. Much of what the reform bill has been trying to assert, we’ve already been doing.”

But, regardless how Wis-consin health care providers are performing, the health care reform has been put in place with the intent to control costs and to make the system more efficient nationwide. “If you look at health care, the cost has gone up double the rate of inflation for a number of years, so the marketplace is demanding that we do a better job of controlling our costs,” says Dan Meyer, president of Aurora BayCare Medical Center. “That is the genesis of why we had this reform law passed – the country can’t sustain this level of cost increase on an annual basis going forward.”Therese Pandl, president and CEO of

HSHS Eastern Wisconsin DivisionDan Meyer, president of Aurora BayCare Medical Center

health care providers respond to legislation


through a federal exchange if the state doesn’t establish one? How much the expansion will cost states is also in dispute. Selberg adds, “There are all sorts of questions tied into the Supreme Court ruling sur-rounding the Medicaid expansion, and we just don’t know what is going to happen.”

Part of the health care reform law has provisions forcing steep federal cuts to supplemental Medicaid payments received by hospitals that serve a large number of uninsured patients. The rationale for the reduction in

disproportionate share pay-ments was that the legisla-tion would produce more patients with coverage.

“In our state we already cov-er a high percentage of our population so I think healt care providers and hospi-tals in this state feel quite negatively about the cut in supplemental payments. We already have very complete coverage,” says Kerwin.

“The disproportionate re-duction also isn’t distributed equally across all 50 states so we don’t know if Wiscon-sin will be reduced under that scenario,” adds Selberg. “For us to predict right now how that will impact hospi-tals is impossible.”

The legislation calls for the creation of health exchanges, which will make qualified health plans available to qualified individuals and em-ployers. The exchanges may be run by the state, or if a state chooses not to establish an exchange, the federal government will develop one.

Whether Wisconsin decides to implement an ex-change is unknown. Selberg adds, “At this point there is no authorization by our executive branch to move forward on the development of an exchange for the state of Wisconsin.”

If Wisconsin doesn’t jump on board the federal government will step in. “I think hospitals and health care providers in general would prefer it is managed by the state because each state is unique, and we could do a better job managing it within Wiscon-sin,” says Kerwin. “It would be better to dovetail on what we’ve already done in the state of Wisconsin in terms of expanding coverage rather than having arbitrary rules imposed on us.”

Given the uncertainty, area hospitals and health care providers echo their commitment to improve value, deliver quality and cut costs. “We believe that will make us successful in serving our community, regardless of all this uncertainty,” adds Selberg.

changes in payments“There are going to be re-ductions in reimbursements, that’s a given, but there are going to be different ways to be paid,” says Meyer. In today’s environment, health care providers get paid a fee for service. In the future, under the Accountable Care Organization within the Af-fordable Care Act, health care providers will be working with employers and groups to manage the total health spend on an organization, explains Meyer.

“What’s happening in the fu-ture, and has already started to happen, is a predomi-nant portion of our payment comes from the fee for ser-vice, but more and more of our payment is going to be tied to quality improvement,” says Dietsche. The list has been started and is growing for those situations that occur post-hospitalization that will not be paid in the future. Health care pro-viders are getting creative in response to health care reform.

Aurora Health Care joined with Aetna to bring employers a new type of commercial health plan designed to improve the health care experience and outcome, while controlling costs. This Aurora Accountable Care Network, set to take affect on Jan. 1, 2013, offers a price guarantee, promising employers improved patient outcomes and greater efficiencies.

Meyer adds, “Those providers that are able to control costs are going to be the ones that survive in the future.”

Bellin Health is using evidence-based clinical practices to look at protocols for chronic disease management and is implementing design flows for how nurses and physicians treat patients. Many hospitals are using lean principles.

“We are trying to manage this population with getting our electronic medical records in place and aligning patients with a primary care physi-cian,” shares Kerwin.

“Approximately 55 percent of our total expendi-tures are wages and benefits so we are looking at how we can better utilize costs in a more ef-fective way. In five to 10 years from now, as baby boomers retire, we know there is going to be an increased demand for health care, and we have to be more effective in the delivery of care. Part of that is through more streamlined processes and operation systems,” says Dietsche.

George Kerwin, president and CEO of Bellin Health

Jim Dietsche, executive vice president and chief financial officer for Bellin Health

Heidi Selberg, vice president, strategy and advocacy at HSHS Eastern Wisconsin Division

greatest areas of concernThe potential cost of the legislation causes health care providers the greatest concern. The cost projections are based on assumptions so states, as well as the federal government, don’t have a firm handle on the cost of this benefit in the future, suggests Kerwin.

He says, “There is an assumption that people will act a certain way and businesses will act a certain way, and I don’t know if that is the case. If businesses drop their coverage for employees and individuals flood the health exchanges, things can play out in a much different way.”

Dietsche feels change creates chaos and confusion. He adds, “If there was an evidence-based platform that could be applied analytically throughout health care I don’t think there would be a debate, but things in health care are gray.”

Pandl’s concern is in the reform’s approach – looking at the per-unit cost reduction without looking at the entire equation of what drives the cost of health care. She says, “We are concerned about the planned cuts, and we can’t tolerate random per-unit cuts. We believe in redesign-ing the payment with a focus on value.”

Pandl supports the Affordable Care Act that rewards improving the clinical outcomes and models that move toward value. She says, “You have to manage the per-unit cost and utilization. If you just drive down one part of the equation you aren’t actually addressing the whole cost of care.”

Hospitals are also bracing themselves for the sequestration scheduled for 2013, which was passed into law and mandates a 2 percent re-duction on health care and all spending programs. “It isn’t being talked about right now because it is like a political football,” says Dietsche. He is convinced health care will be taking the 2 percent reduction, although he wonders if it will be more.

the upcoming november election brings more uncertainty“Regardless what happens on Election Day, even if the law gets re-pealed, the fact still remains that health care costs are much higher than the rate of inflation. We are spending more and more as a country on health care. Employers and the government paying the bills will continue to demand we get a better control of the system. I don’t see this concept or philosophy going away,” adds Meyer.

“We live in a world where health care is socially, politically, technologi-cally and economically complex,” adds Pandl. “With the intersection of the federal deficit, health care reform and the aging demographic, we can’t ignore this. We can’t ignore the improvements that are needed, but the uncertainty definitely makes forward progress challenging.”


With a national health care system in place, what will happen to your friendly neighborhood insurance agent?He’ll probably look and act a little more like a consultant or adviser than a broker of insurance policies.

“I believe our role will be expanded,” says John Ulness, owner of Ul-ness Health Insurance/Wellness. “It will be a different role; we’ll be doing more things than ever before as far as educating people, creat-ing greater transparency, working with providers, working with medical systems, working with doctors, working with hospitals to help educate patients so doctors are able to add more value rather than wasting doctor time.” Ulness works in the individual, small group employer and Medicare market but foresees wellness playing a bigger role in the health care and insurance system, which is why he named his business as he did. “I have plans to be wellness consulting but am positioning my busi-ness in case in five years we are on a one-payer system and what I will do (as an insurance broker) will no longer be compensated,” he says.

“There are some fairly big changes with new parameters and new re-quirements being communicated in short periods of time, with limited resources in some cases, in order to be able to get answers,” adds Graham Ness, partner at Forsite Benefits in Green Bay.

Companies are counting on firms like his to answer questions regard-ing the new SBC, or Summary of Benefits and Coverage, a four-page document employers had to have in the hands of employees by Sept. 23 of this year.

Then there were the new minimum loss ratios (MLRs) that kicked in this year. Insurers like United HealthCare found out earlier this summer that if they hadn’t met these minimum standards, they owed money to their clients.

insurance industry responds to health carereformlee marie reinsch TEXT submitted PHOTOGRAPHY

The MLR clause means insurance companies have to spend a cer-tain percentage of the money paid to them in insurance premiums on actual medical care, rather than things like administrative costs or marketing.

“To give you an idea of the time frame, this notice came July 13 and checks had to be distributed by Aug. 1,” Ness says. “Our clients are more reliant on us as the ones to do that research and get those an-swers because things are moving very quickly.”

Ness and his partners are making sure that as they’re out talking to the businesses they serve, they’re keeping in mind not only the components of health reform that are “known and set in stone” but also those coming down the pike. Former Defense Secretary Donald Rumsfeld would have tabbed them “known unknowns” and “unknown unknowns.”

Ness and his partners at Forsite are talking about the knowns, preparing for the known unknowns and bracing themselves for the unknown unknowns.

“One of the biggest unknowns right now is the exchange component,” Ness says.

By exchange, Ness refers to the marketplace or marketplaces that may be established to help consumers compare and purchase insur-ance plans. “The concept is that there will be a website and there will be (a number of insurance) options and they will pick a plan and that’s it,” Ulness says.

But where do agents fit in? “It’s up in the air whether agents will be involved,” Ulness says. “There is a chance they could be squeezed out, but there is just too much that people need help with.”

Ness says even though the exchanges haven’t been clearly defined at this point, they’re a relatively large piece of health care reform. Individuals who don’t have insurance through their employer or who are inadequately insured through their employer may end up choosing a plan through the exchange.

“You have insurance carriers trying to decide what changes they need to make to operate inside and outside the exchanges,” Ness says. “Em-ployers are asking themselves, ‘If I am going to dissolve my insurance plan, am I comfortable telling my employees, ‘Hey, go to the Internet?’ Not all people are able to make those decisions themselves.”

Ness sees that firsthand at the employee benefit meetings his com-pany hosts for employers.

Even when the employer has chosen the insurance plan for them, and they bring in benefits experts to explain the plans at an employee Q&A, employees still get confused about what’s covered and what’s not covered, Ness says.

He says consumers rely on them as the liaison between insurance company and employer.

“We field many calls on a daily basis from employers and employees saying, ‘I got this explanation of benefits and I can’t make heads or tails of it. Is there an error?’” Ness says. “We are engaging with people on a daily basis.”

“To think we can put a website in place to replace the human element that insurance agencies provide. I don’t think so.”


Graham Ness, partner, Forsite Benefits in Green Bay

John Ulness, owner, Ulness Health Insurance/Wellness

“I believe our role will be expanded.” — John Ulness, owner, Ulness Health Insurance/Wellness

“Our clients are more reliant on us as the ones to do that research and get those answers because things are moving very quickly.” — Graham Ness, partner, Forsite Benefits in Green Bay

16

The Affordable Care Act issued in March 2010 brought about big changes for insurance companies. While the legislation is being rolled out in phases, extending dependent coverage to age 26, eliminating pre-existing condition restrictions for children and removing lifetime health care limits has already taken effect. By 2014, the industry will see the biggest changes to date – insurers must provide coverage to people with pre-existing health conditions, and individuals are required to obtain health insurance coverage or pay a fee.

The legislation has a potential upside for insurers with the increased number of people who will be seeking coverage, but the true tale of how the laws will impact insurance companies remains to be seen.

“The impact of some of the leg-islation has already been felt but more will be felt in the ramp up to 2014,” says Pat Osborne, gov-ernment relations consultant for Alliance of Health Insurers. “We will have a considerably different world in terms of marketing insur-ance plans and selling them.”

The establishment of health exchanges is going to provide new coverage opportunities. The state-level health insurance ex-changes to be created under the Affordable Care Act are expected to play a major role in the purchase and sale of health insurance when they become fully operational in 2014. “The establishment of exchang-es affects the commercial market dramatically. It provides a significant new type of marketing challenge. A large number of individuals, and potentially a large number of small businesses, will be looking at making their health insurance purchase from this new entity,” adds Osborne.

Exchanges are unlike what is seen in the marketplace today, which Os-borne explains creates both challenges and opportunities for insurers. “It’s hard to say exactly what that range of challenges and opportunities is going to be. A lot of it depends on how the exchange is, who runs it and what the rules and requirements are,” he says. “Some of it is spelled out in the federal legislation, but a lot of it is optional for the states and to be determined.”

Under the Affordable Care Act, states are charged with setting up their own exchange; however, if the state chooses not to comply, the federal government is able to step in. Organizations like the Alliance of Health Insurers favor the establishment of the state exchange as opposed to defaulting to a federally facilitated exchange.

Osborne shares one of the reasons for opting for, or preferring, a state exchange is because each marketplace is different. “We just feel the state has a better handle on the Wisconsin marketplace and what makes sense for the operation of an exchange in Wisconsin,” he says.

The fact that Wisconsin has chosen to delay the implementation of a state exchange isn’t optimal from an insurer’s perspective. “We recog-nize there are political considerations that are very real in terms of the future direction of the whole federal act, but that complicates the readi-ness of businesses,” says Osborne. “Like any and all businesses, it’s hard to plan well for the future with the uncertainty that continues to surround the future direction of the state implementation of the federal law in Wisconsin. It’s not ideal but we understand where the administra-tion is right now.”

When the state reaches the point of discussion and debate about the type of exchange to implement, Os-borne explains most insur-ers would prefer a clearing house-type exchange versus an active purchaser arrange-ment. He says the distinction between the two is illustrated in the Utah versus Massa-chusetts model.

“A clearing house-type of ex-change is one that we would favor as health insurers be-cause basically you set up an access point for people inter-ested in purchasing health insurance with carriers who are qualified under the re-

quirements put forward in the federal act. Any insurer that can make those qualifications, from our perspective, should be able to sell on that exchange,” says Osborne.

Massachusetts has the active purchaser model where the requirements to participate on the exchange are set up statutorily so only a limited number of insurance plans can participate or only plans that agree to specific terms may participate.

If implemented as currently laid out in the federal law, exchanges would be a huge piece within the health insurance market. Osborne adds, “We would like an open process where as many competitors as wanted could try to sell plans on the exchange.”

When considering the health plan design, one critical component is the essential health benefit – what a plan on the exchange must cover. Os-borne explains the federal act has prescriptive requirements with some flexibility in how that is ultimately defined.


insurers react to reform lawsJennifer hogeland TEXT submitted PHOTOGRAPHY

“A lot of it depends on how the exchange is going to be set up, who runs it and what the rules and requirements are that are associated with that exchange.” — Pat Osborne, government relations consultant, Alliance of Health Insurers

insurers react to reform lawsTo ensure comprehensive coverage, there are a handful of elements that essential health benefits must include; it will likely be measured against a benchmark plan.

While the health care legislation is changing the design of many insur-ance plans, the face of consumers who are traditionally insured may also look very different. The law states affordable coverage should be offered to everyone, although some may opt to pay a penalty rather than buy individual health coverage. Insurers are currently trying to estimate the price consumers, specifically healthy individuals, will be willing to pay for coverage.

According to a June 30, 2012, Wall Street Journal article, the stakes are high for Blue Shield, a nonprofit. The company got $987 million of its total $9.7 billion in revenue from sales of plans to individual consumers last year. California academic researchers projected the fed-eral overhaul could increase the number of individuals buying their own plans by nearly 70 percent, to 3.85 million in 2019 from around 2.29 million that year without the law.

The Wall Street Journal article states, “That creates an opportunity, but also a risk. If Blue Shield plays it wrong, and does a bad job predicting who will buy its plans and how pricey their care will be, the company could end up selling insurance at rates that don’t cover its costs, or see premiums spiral upward as healthy consumers stay on the sidelines while those with higher claims costs rush to get coverage.

“Though the law includes some safeguards against this, designed to help financially protect insurers that attract a large number of high-risk patients, it’s not clear exactly how they will work.”

The same Wall Street Journal article shares the findings of Mike Benoy, a Blue Shield actuary who researched predictions of what two hypo-thetical 32-year-olds on limited incomes would do, with realistic pre-mium options, under the health overhaul.

“The sobering finding: the healthy one, who was in the category of consumers with the lowest expected medical costs, was only about 24 percent likely to buy insurance, despite the new federal subsidy and penalties for being uninsured. The one with health risks had about a 99 percent likelihood of buying a plan.” Blue Shield notes those estimates are preliminary and could change.

Osborne says, “There will be very significant and dramatic changes in health insurance coverage – how people might purchase it, what it might cost them depending on where they are on income status – but a lot of things that go into those equations as to how many people are af-fected or what the ultimate effect will be, is still in the to-be-determined stage.” He says the federal government has yet to come down with final rules and regulations or guidance on some of the key elements on plan design.

An upward impact on premiums appears inevitable. He explains much of what will happen with the federal act is cost shifting. If insurance companies are prohibited from not underwriting an individual or aren’t able to rate risk based on age or other factors, they will be forced to find a way to cover their costs. Osborne concludes, “You are going to end up shifting premium increases from one category of individuals to other categories of individuals. That is the nature of how the provisions will end up working in the insurance world.”


The continuing

politics of health care reformBy: Nan Nelson

In summer, the U.S. Supreme Court ruled on the 2010 Afford-able Care Act, the health insurance reform law, upholding the law’s mandate requiring Americans to carry health insurance or pay a penalty which the court ruled is a tax. The court also ruled the federal government could not expel states from Medicaid if they refuse to go along with expanding eligibility for the program, as required in the new law. Unfortunately, for businesses desiring some certainty about the future, that is not the end of the story.

The November elections could mean repeal of parts of the law because of a quirk of Senate rules called budget reconciliation. It allows the chamber to pass tax-related legislation with only 51 votes instead of the usual 60 needed to overcome filibuster. Now that the Supreme Court has determined the mandate is a tax, if the Republicans gain a few seats to take control of the Senate, gain the presidency in the election, and hold onto control of the House, the law could be gutted of the mandate, the Medicaid expansion and some major spending pieces, although insurance industry reforms would remain. States like Wisconsin are awaiting the election results to determine next steps.

In addition, even if parts of the new law are not repealed, many industry groups are looking to modify its impact through future amendments or mitigation of its provisions during implementation rulemaking, including:

Some hospitals looking to avoid or scale down the sched-•uled $155 billion in federal payment cuts due to the loss of patients that is likely if states opt out of mandated Medicaid coverage expansionManufacturers looking to scale back the medical device tax•Insurers looking for more leeway to charge older people •more for insurance than young people (up to 5 times as opposed to the law’s three time-limit)Drug makers looking for more generous Medicare •reimbursement price scalesEmployers looking for reduced •penalties and more time to complyInsurers looking to shorten •enrollment windows and gain ability to impose late sign-up penalties to combat people waiting until they’re sick before buying coverage

This issue will be with us in some form for a long time to come.


In KI’s human resources department, Benefits Manager Jodi McWil-liams is scurrying to meet deadlines and find answers. She’s keeping up on the day-to-day, play-by-play of the Patient Protection and Afford-able Care Act (PPACA) as its varying deadlines creep nearer for 2013 and 2014.

Her department has felt the impact of increased administrative costs to meet these deadlines, the most recent being the Summary of Ben-

efits and Coverage (SBC) that was due Sept. 23. “It’s just one more thing we have to do,” McWilliams says.

But so far, the largest effect the nationwide office-system manu-facturer has felt from health care reform is one many Wisconsin employers had already felt before the national reform took effect: the adult-dependents clause.

The clause enabling adults under age 27 to be covered under their

parents’ insurance policies was among the first of PPACA’s changes to take effect, back in September 2010. But Wisconsin already had a similar mandate in place. Still, national and international companies such as KI found themselves with more names on their rolls when the president’s national directive took effect. Some 60 adults under age 27 joined the KI employee health-insurance plan, McWilliams says.

“That was our big one — the dependents coming onto our insurance,” McWilliams says. “That did cost us quite a bit of money.”

big cost no matter how you slice itHealth insurance costs quite a bit of money for any company, let alone one with several thousand employees. With some 1,400 people on its insurance coverage, KI’s budget for medical costs is $9 million per year. “Our package is about $6,500 per person per year, and that is low,” McWilliams says.

They’re able to keep premiums low by keeping deductibles high. KI offers two such plans, with deductibles from $1,500 to $3,000 for individuals and $3,000 to $6,000 for families.

While they’re able to grandfather their current plans through 2013, that might not be the case in 2014, when PPACA’s limits on deduct-ibles and premiums kick in. Since KI’s insurance plan is self-funded, it may not be subject to the same scrutiny that a fully funded plan may be, but there will still be certain parameters.

af·ford·a·ble [uh-fawr-duh-buhl] adjective: that can be afforded; believed to be within one’s fi-nancial means.

One thing the word “affordable” in the PPACA refers to is how much an employee has to pay for single cover-age in relation to his or her wages. If it’s more than 9.5 percent, then the new law says it’s not affordable, says Dave Flotten, senior human resources con-sultant, Associated Financial Group. “If the coverage is not affordable to employees, that may trigger a penalty,” Flotten says. He’s referring to the tax that can be levied against employers (and individuals) for not complying with the Affordable Care Act.

Companies with fully funded insurance plans will have to limit their deductibles to $2,000 per individual and $4,000 per family, or else kick in a little to make up the difference. “(Employers are asking), ‘Do I increase the amount I contribute to health insurance to make it more affordable? How much more do I contribute and how much do I accept I might get hit with this affordability penalty?’” Flotten says.

coMpanies’ take on the Affordable Care Actlee marie reinsch TEXT submitted PHOTOGRAPHY

Jodi McWilliams, benefits manager, KI

“(Employers are asking), ‘Do I increase the amount I contribute to health insurance to make it more affordable? How much more do I contribute and how much do I accept I might get hit with this affordability penalty?’” — Dave Flotten, senior human resources consultant, Associated Financial Group

Dave Flotten, senior human resources consultant, Associated Financial Group


Or should they drop their plans altogether?

Some say the penalties are so small compared to the cost of premiums that employers could end up opting to pay the penalty.

“In a lot of cases it’s more financially advantageous for the employer to dump the health plan, the way (the law) is written now, at least,” says Tammy Steber, consultant, Warren Risk Consulting.

But it doesn’t sound like many large employers want to do that. “Even those that do because the penalty is smaller than the premiums find that there are hidden costs” associated with dropping their plans, Flotten says.

“It’s unrealistic to think employees aren’t go-ing to have their hands out, saying, ‘What are you going to give me now that you’ve taken this away?’ So that wipes out some of the savings,” Flotten says. “You will lose your tax breaks. Plus you raise questions about em-ployee retention, questions about attracting new employees, questions about morale. For a lot of employers, it doesn’t make sense to drop their plans.”

McWilliams says KI considered dissolving its coverage but decided against it. “We had to think of our company as a whole,” she says.

Steber says she’s been hearing large employers saying the reform is not going to have a huge effect on the way they do business.

“They want to know what the overall financial impact will be and if there will be additional fines,” she says. “A lot of them, although they don’t have to have the mandates in there (yet) are saying, ‘We may as well put them in, because they will need to go in anyway.’ Large employers are saying it’s not going to change much, and smaller employers are saying, ‘I don’t know what I’m going to do with this. It’s just one more burden; how am I going to stay in business and finance this?’”

As of 2014, employers will have to provide insurance coverage to full-time employees, and the law defines a full-time employee as one working 30 or more hours per week. “Right now, some employers don’t cover everybody down to that level, which means they’re going to have to expand their coverage to part-timers,” Flotten says.

“In a lot of cases it’s more financially advantageous for the employer to dump the health plan, the way (the law) is written now, at least.” — Tammy Steber, consultant, Warren Risk Consulting

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Tammy Steber, consultant, Warren Risk Consulting

20

For the vast majority of entrepreneurs and small businesses, problems accessing and providing quality, affordable health benefits have always been a struggle. On average, small businesses pay more. Costs get even higher for the nation’s 21 million solo-preneurs, or when factoring in a pre-existing condition or family.

The affordability and access to insurance is a big consideration for people thinking of going out on their own, or working for a startup. In 2010, researchers at the Kauffman and Rand Institute found that lack of comprehensive health coverage negatively impacts the rate of business startups. This has some optimistic that provisions in new health care law could put a leash on out-of-control insurance costs and drive more entrepreneurial ventures and small business growth. On this point, today’s small businesses and entrepreneurs are hopeful and skeptical at the same time.

“Not having health insurance worries me,” says Nicole Zich, owner of Sassy Girl, a small boutique on Broadway Street in Green Bay. Like many entrepreneurs trusting their health, Zich has gone without health insurance since she opened her business.

“Often, my income fluc-tuates. When it comes down to making payroll, or paying a very costly insurance premium, I have decided to take the chance and not carry health insurance,” she says.

In 2014, when she will be required to purchase insurance or pay a tax, Zich stated that she will most likely buy health insurance through the state-operated exchange.

“As long as it is affordable,” she adds.

Others, including Zich, are wondering if insurance costs will be reduced when more people, including those who currently don’t have insurance, like her, will be pooled together. The exchanges will only work if there is a balance between the healthy and the sick. An Inc. article recently stated that in Massachusetts, from which parts of the national health law has been modeled, more people now have insurance, but costs are still rising. This is due in part to the fact that the uninsured that got cover-age were in worse health than anticipated.

Now, for small businesses that intend to add employees, reduction of insurance costs is critical to growth. Scott Bushkie, of Cornerstone Business Services, currently employs fewer than 10 people. For his mergers, acquisitions and business brokerage firm, providing benefits is an absolute must.

“When hiring, it definitely helps to provide health coverage as part of our benefit package,” he says. He also noted that having health benefits adds to the value of a company. His opinion is backed by a Truven Health Analytics study published this summer. It reported that not providing health coverage would have an enormous negative

effect on an employer’s market position.

While Bushkie is not necessarily sure that the Affordable Care Act will solve the cur-rent raises in insurance costs his firm deals with annually, he is keeping a close eye on its development to determine his next steps.


“When hiring, it definitely helps to provide health coverage as part of our benefit package.” — Scott Bushkie, owner, Cornerstone Business Services

Health care coverage challenges

entrepreneurscorenne gutierrez TEXT submitted PHOTOGRAPHY

Nicole Zich, owner, Sassy Girl

Scott Bushkie, owner, Cornerstone Business Services

“When it comes down to making payroll, or paying a very costly insurance premium, I have decided to take the chance and not carry health insurance.” —

Nicole Zich, owner, Sassy Girl

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With plenty of green space and mostly residential neighbors, Aurora BayCare Medical Center doesn’t feel like a city hospital. Located at 2845 Greenbrier Rd. on Green Bay’s east side, it’s amazing how many people occupy the 167 bed, full-service hospital at any given time.

Aurora BayCare opened in September 2001 as a joint effort of Aurora Health Care and BayCare Clinic. Aurora Health Care is a not-for-profit health care provider. BayCare Clinic is the largest physician-owned, specialty-care clinic in Northeast Wisconsin and the Upper Peninsula of Michigan. Aurora Bay-Care follows the Planetree model that helps patients feel more at home. Building design separates public corridors from patients.

Though Aurora BayCare is always busy, you wouldn’t necessarily know it; the hospital is quiet and comfort-able. Would you see the impressive teaching hospital, the bright-eyed med students and the well-deserved accolades? Probably not at first glance, but you would by taking a behind-the-scenes look.

Warming upIn July 2011, Aurora BayCare Medical Center be-came the first teaching hospital for rural curriculum in Northeast Wisconsin. The Wisconsin Academy for Rural Medi-cine (WARM) program was instituted to address rural communities underserved by physicians in family care, primary care, OB-GYN, general surgery and more. The program, within the University of Wis-consin School of Medicine and Public Health in Madison, aims to “in-crease the number of physicians practicing in rural Wisconsin and to improve the health of Wisconsin communities.”

According to the University of Madison, course objectives include in-troducing students to community and family-oriented medical care, teaching students about health issues specific to communities includ-ing issues of health care delivery, enabling students to understand the social structure of communities and how health care and preventive medicine efforts relate to this. OB-GYN is a very popular field of study, as is anesthesia, and sports medicine. Additional areas of focus are added each year.

The primary objectives of Aurora BayCare Medical Center are to help patients to restore their own health and/or maintain their own health. Students see how this is done both through medicine and by adhering to the Planetree model of health care. Those enrolled in the Wisconsin Academy for Rural Medicine act as interns working directly with the attending physician. Students demonstrate independence as would a

primary care physician. Faculty and instructors provide a model, teach-ing students what it means to be responsible.

Medical students in the WARM program number approximately 100 each year, but students learn in small groups. WARM was active in Green Bay for six months of 2011. In that time students received 278 weeks of clinical rotation and more than 12,000 hours of education. 2012 is expected to see numbers at twice that volume.

meet the med studentsBre Anna Nagle from Waupun, Wis., is a third-year medical student on her second rotation. She grew up in Fox Lake, a small town with a current population of about 1,500. The WARM program appealed to Nagle because of her familiarity with rural life and the shortage of health care professionals. Fox Lake didn’t have a doctor when Nagle lived there; they had to travel for health care. As Nagle started seri-ously considering her career path she did job shadowing to see what being a doctor would really be like. “The WARM program at Aurora BayCare Medical Center was a newer program, but I’d already heard many positive things about it. It has certainly met my expectations,” she says. She enjoys working directly with the attending physician. “There’s less time observing and more time assisting,” she adds. Nagle says the most gratifying thing about what she’s doing as a student

a behind-the-scenes looK at Aurora BayCare Medical Center terra l. fletcher TEXT terra l. fletcher and submitted PHOTOGRAPHY

Bre Anna Nagle, a third-year medical student on her second rotation, is pictured in a nursing station at Aurora BayCare Medical Center.


is to see her care have an impact on the patients. A highlight of her experience at Aurora BayCare was delivering a baby.

Chris Reiff joined the WARM program because of a desire to serve an underserved population. He wanted the ability to practice in his home state of Wisconsin and needed to be close to his family. Hailing from Manitowoc, Aurora BayCare Medical Center seemed like the right choice. Reiff did a clerkship in Green Bay between his first and sec-ond year of medical school. The culture and atmosphere felt right, and Reiff admits the impressive workout facility sealed the deal. Reiff says the most gratifying thing right now is “seeing the medical knowledge I’ve gained come together to help somebody. I can follow the whole medical chart, understand why they came in and practically apply all the book knowledge I’ve had to this point.” Reiff is also a third-year medical student.

Aurora BayCare Medical Center’s Dr. Richard Ludgin, vice presi-dent of medical affairs, used an analogy to explain the benefits of the WARM program. He called it “translational education.” The pro-cess begins with creating a knowledge base and then translates into application.

giving back and paying forwardOne aspect Dr. Ludgin is most proud of is the fact that the Wisconsin Academy for Rural Medicine program has had such wide acceptance. The staff is not paid to teach, though there is a small stipend for clerk-ship directors. Everyone else gives of their time simply to give back. When Dr. Ludgin was asked why Aurora BayCare participates in the program he says, “Why do it? How can you not do this?”

Dr. Ludgin says that having medical students around keeps every-one honest. “In order to teach, our staff must have a higher level of knowledge. You can’t just know how to do your job. You have to know why, answer questions and be able to explain it…There is definitely a bilateral education here. Students are taught by all professionals at Aurora BayCare; pharmacists, nurses, doctors, clerkship directors and of course – patients.”

What’s next for students like Nagle and Reiff? Aurora BayCare Medical Center would like to keep students in the state and more importantly have them serve rural communities. After their time at Aurora BayCare, Nagle and Reiff will pursue a postgraduate educa-tion. Dr. Ludgin hopes their experience in Green Bay is a positive one;

that they develop lasting relationships, and hopefully they’ll come back to Green Bay.

clinical researchAurora BayCare’s behind-the-scenes tour includes a peek at the clinical trials, courtesy of Supervisor of Clinical Research Annette Paul. In addition to can-cer, neurology, orthopedics and cardiology studies are being performed.

Near to Paul’s heart is the study of multiple sclero-sis (MS). Unlike cancer, MS does not benefit from a high level of awareness. Nor is the research for MS government funded. The disease is difficult to diagnose because neurological symptoms are often dismissed until the disease has progressed for some time. “This is a real, debilitating disease that people don’t recover from,” says Paul.

“We want to raise awareness of the high incidence of MS in Wisconsin. It’s a real problem here, but at Aurora BayCare we’re doing something about it. Our patients are getting the best prescription drugs, even if they are still in the study phase, not yet approved by the FDA. The lat-est drugs offer a lot more hope for MS sufferers to keep functioning - at a higher level, for a longer time. It’s all about quality of life.”

Paul related an experience of a patient who had been receiving treat-ment for MS for some time. She switched to a trial drug and now the symptoms of MS are less progressive. Paul has seen patients who were previously suffering from seizures or needed leg braces to walk. Many MS patients have experienced a reduction in their symptoms.

Chris Reiff and Bre Anna Nagle, participants in the Wisconsin Academy for Rural Medicine (WARM) program at Aurora BayCare Medical Center, observe in a patient room.

Dr. Richard Ludgin, vice president of medical

affairs, Aurora BayCare Medical Center

aurora baycare in the news/awardsAurora BayCare earned the distinction of “Best Hospital in Northeast Wisconsin” by U.S. News & World Report rankings (2012-2013). Aurora BayCare ranked as the eighth-best hospi-tal in Wisconsin with high performance in geriatrics, gynecology, nephrology, neurology and neurosurgery and orthopedics. Clearly Aurora BayCare Medical Center is striving to fulfill its mission of being “committed to providing the highest quality comprehensive health care through superior personalized service, the advance-ment of medical education and research, and the most efficient use of resources.”


“I get by with a little help from my friends.” Could the lyrics from a well-known band in British rock history soon be used in the context of small business ownership?

In my role as marketing director for the local Green Bay Chapter of SCORE, I’ve seen firsthand the passion local entrepreneurs possess. However, anyone who has taken the steps toward starting a business knows that passion only carried you so far. You inevitably must find a way to pay for the dream to become a reality. The traditional bank loan method is getting more difficult by the day, so what can the dreamer do to get their million-dollar idea to the market? Could crowdfunding be the answer?

Kevin Eismann, founder of Epiphany Law and Angels Investors Anony-mous, shares these insights into this growing topic and sheds some light on how it might affect the future of small business.

Chad Heath (CH) – Break it down for us, Kevin, what is crowdfunding all about and who should be using it?

Kevin Eismann (KE) - Donation/reward funding is basically what peo-ple perceive as “crowdfunding” in its current, permissible form. People can donate small amounts to entrepreneurs through websites such as “kickstarter.com” or “indiegogo.” Instead of a return on their invest-ment, investors receive a giveaway item, such as a T-shirt, one of the products or books, or a meeting with the author, often depending on

the amount of the investment. Because no real returns are provided in exchange for donations, this type of funding has been able to happen under current securities regulation.

Investment crowdfunding is a similar concept, where a startup rais-es a desired investment by getting small commitments from a larger number of people. The difference here is that these investors are still profit-motivated, expecting ownership or a return on their investment. With the passing of the JOBS Act, there is much buzz surrounding the crowdfunding concept, but entrepreneurs should be cautioned that they cannot rely on this exemption until the SEC completes its rule-making, and nobody quite knows when this is going to happen.

Crowdfunding is perfect for a creative project, such as a book or mov-ie, or a unique product. These companies are able to attract funding from enthusiasts or from individuals who just want to be a part of something they are excited about — whether it be helping their favorite band make a new album or getting a new gadget for their iPad.

CH – Of what should the entrepreneur interested in crowdfunding be wary? How about the investor?

KE - For the entrepreneur, crowdfunding, particularly where no own-ership is given, may be a perfect fit for certain types of projects or where a relatively small amount of capital is required. Beyond this, it is going to be expensive and an administrative nightmare. Like with all securities offerings, the issuer and its principals have the poten-tial for liability for misrepresentation, whether or not intentional. And

BUSINESS SPOTLIGHTTEXT chad heath and KeVin eismann

the appeaL of

fundingC R O W D


it is simply a numbers game — by increasing the number of investors, you’re increasing the odds that if things don’t go as planned, you’ll have someone who wants to make a claim against you.

For the investor, the risks are largely the same, all boiling down to loss of investment, albeit here a smaller amount. But with the number of startups who will view this as an easy way to raise money, the potential for fraud is greater.

CH – Where do you see this going? Do you expect crowdfunding to be used on a local level or do you expect this to grow with online portals?

KE - This is probably going to grow with the portals. In order to comply with the exemption, the investment must be conducted either through a broker or a funding portal.

At this point, typical broker-dealers don’t seem to be too enthused with the idea, but given the use of the Internet, and the publicity and success the current crowdfunding sites are having, I don’t see it going any other way.

For now, the full story on crowdfunding is yet to be written. There will be many opinions shared and much advice disposed in the coming months. Seek advice from experts such as Eisman and examine the facts closely as this comes to market. The viability of this business funding option should come into focus for you soon.

Chad Heath is an insurance professional with Alliance Insurance Centers, marketing director with Green Bay SCORE and a community and small business advocate. To learn more, visit www.linkedin.com/in/chadjheath.

Kevin Eismann is the founder of Epiphany Law and Angels Investors Anonymous. Eismann counsels clients exclusively in business law. He has been providing business owners with practical, cost-effective solutions since 1996. He can be reached at www.epiphanylaw.com or [email protected].


BOOK REVIEWREVIEWED BY Jeanette Jacqmin, LIBRARIAN, BROWN COUNTY LIBRARY

Your organization may be smart, but is it healthy? Here’s what Lencioni’s The Advantage can show you:

• Howbeinghealthybenefitsanorganization• Whatittakestobuildacohesiveleadershipteam• Howtocreateclarityandwhyyouneedtoover-and-over- communicate it• HowtoanswertheSixBigQuestionsandestablishThe Playbook• Howtobuildstructuralclarityandincludeitinthelifecycle of the employee• Howthecentralityofgreatmeetingscanbenefityourtime and leadership• Whatultimateimpactorganizationalhealthhasonand beyond the organization

“An organization that is healthy will get smarter over time without politics and confusion getting in the way of identifying critical issues, recovering quickly from mistakes and solving problems on all levels.”

According to The Advantage there are two requirements for success-ful organizations: being smart and being healthy. Most are smart, but few focus on organizational health, the “multiplier of intelligence,” ac-cording to the author. Do you recognize these healthy signs in your organization: minimal politics, minimal confusion, high degrees of mo-rale and productivity and a very low turnover rate of good employees?

To become healthy an organization needs to embrace four disciplines: • abehaviorallycohesiveleadershipteam;• claritythroughintellectualalignmentandcommitmenttosix critical issues and answers; • repetitiouscommunicationofthatclaritytoemployees;• reinforcementofthatclarityineverypolicy,programand activity involving employees.

The first steps must come from the top, which is often difficult be-cause leaders must move out of their operational comfort zones.

Building trust is the first behavioral principle the leadership team must embrace, a venerability-based, “deep and uncommon sense of

trust” among its members. The only way for a leader to create a safe environment for the team to do this is by stepping up and doing some-thing that feels unsafe and uncomfortable first. Trust is followed by mastering conflict, achieving unilateral commitment, peer-to-peer accountability and focusing on results.

Mastering conflict involves overcoming discomfort avoidance to seek productive ideological conflict, including “mining” for potential or sub-tle disagreements in the room. From that conflict comes clarity and a commitment on which everyone in the team must weigh in.

While conflict involves issues and ideas, accountability is about per-formance and behavior. Lencioni calls peer-to-peer accountability the “primary and most effective source of accountability on a leadership team.” He explains that competitive advantage and massive benefits go to organizations where leaders hold one another accountable.

His final discipline focuses on results, organizational results, not departmental results. Collective organizational goals shared by the entire leadership team, regardless of individual departments success-es, can create synergy. “The ultimate point of building greater trust, conflict, commitment and accountability is one thing: the achievement of results.”

Once you have a trust-based, organizationally focused leadership team, your team needs to create clarity and achieve alignment by com-municating the same clear and consistent messages to employees all across the organization. Lencioni provides “Six Critical Questions” that the team must jointly answer and then rally around. This is the most important step in his plan for organizational health.

The six questions discussion includes identification of values, which “are critical because they define a company’s personality and provide employees with a clarity about how to behave … reduce microman-agement, attract the right employees and customers, and repel the wrong ones.” For core values that uniquely define the organization, he recommends unique, non-traditional terminology defined by vivid, behavioral descriptions.

The final critical question helps the team identify the company’s im-mediate top priority with the most direct impact on it, and he sug-gests that a thematic goal or “rallying cry” be created around which

AUTHORS Patrick Lencioni PUBLISHER San Francisco, CA: Jossey-Bass 2012; Recent acquisition at the Brown County Library

The AdvAnTAge: Why OrgAnizATiOnAl heAlTh Trumps everyThing else


n The Drama-Free Office: A Guide to Healthy Collaboration with Your Team, Coworkers and Boss

Jim Warner and Kaley Klemp Greenleaf Book Group Press, Austin, TX, 2011

n The Great Workplace: How to Build It, How to Keep It, and Why It Matters

Michael Burchell and Jennifer Robin Jossey-Bass, San Francisco, CA, 2011 by Great Place to Work® Institute Inc.

n Healthy Employees, Healthy Business: Easy Affordable Ways to Promote Workplace Wellness

Ilona Bray and a nationwide team of experts Nolo, Berkeley, CA, 2009 & 2012

n Workplace Wellness: Performance With a Purpose Dr. Rose Karlo Gantner Ed.D.CD NCC, 2012.

More by Patrick Lencioni

n Overcoming the Five Dysfunctions of a Team: A Field Guide for Leaders, Managers, and Facilitators

E-book Recorded Books, 2011, and print Jossey-Bass, 2005.

n Getting Naked: A Business Fable — About Shedding the Three Fears That Sabotage Client Loyalty,

e-book Books on Tape, 2010.

n The Three Big Questions for a Frantic Family: A Leadership Fable About Restoring Sanity to the Most Important Organization in Your Life

Jossey-Bass, 2008.

n The Three Signs of a Miserable Job: A Fable for Managers (and Their Employees),

e-book Overdrive and print Jossey-Bass, 2007.

n Silos, Politics, and Turf Wars: A Leadership Fable about Destroying the Barriers that Turn Colleagues into Competitors

Jossey-Bass, 2006.

n Death by Meeting Death by Meeting: A Leadership Fable — About Solving the Most Painful Problem in Business Jossey-Bass, 2004.

n The Five Dysfunctions of a Team: A Leadership Fable Jossey-Bass, 2002.

n Obsessions of an Extraordinary Executive: The Four Disciplines at the Heart of Making any Organization World Class

Jossey-Bass, 2000.

n The Five Temptations of a CEO: A Leadership Fable Jossey-Bass, 1998, 2008.

Additional titles available through the Brown County Library:

all employees can focus their particular work, providing the temporary qualitative focus for the operation of the organization.

The Playbook, a concise distillation of the answers to the Six Critical Questions presented in an brief, actionable way, can be used going forward for all organizational communication, decision-making and planning, and leadership team members should keep it with them at all times, and be able to answer the Six Critical Questions whenever they need to communicate with employees.

Once the Playbook has established clarity it needs to be communi-cated consistently over time, and Lencioni recommends “cascading communication” that includes message consistency between leaders, delivery timeliness, and live, in-your-own-words communication.

To reinforce clarity, the Playbook answers are built into the structure of the organization. Leaders take an active role in the building of human systems that reflect the uniqueness of their culture and operations, in part through incorporation into the recruiting and hiring of employees, orientation, performance management, compensation and recognition.

Lencioni has written a number of fabular books on topics useful to organizations, including one on meetings. Here he provides his exper-tise on what kinds of meetings are needed, what should be dealt with

in them and how meetings can be highly beneficial to an organization. By participating in the right meetings, leaders can avoid spending time with issues that come about because they haven’t been resolved in a meeting in the first place.

Advice for implementation of the plan to creating organization health includes acknowledgement of the “genuine sacrifice and commitment, a monumental and selfless task,” required by the person in charge who must be the first to do the hardest things, the driving force behind the critical answers, who must not give up or delegate responsibility for communication and reinforcement of clarity.

Additionally, we are reminded that this is a process. One that requires ongoing attention to maintaining leadership team cohesiveness, re-visiting the critical questions and answers, and communicating and reinforcing them. Pages 195-197 contain a complete Checklist for Organizational Health, just one of several helpful lists and diagrams included in this book.

Lastly, he leaves us with the thought that ultimate impact, the clarity, hope and anticipation of going to work each day and the greater sense of accomplishment, contribution and self-esteem coming home at the end of the day, may extend beyond the organization and its employees to customers and vendors, and even to employees’ families.

Check out the staff picks for business, small business, and other books at pinterest.com/browncountylib


dan rocheleauhorticultural specialist, st. mary’s hospital medical center

What kinds of duties are associated with your job?“I was brought on to maintain and take care of the Green Roof and make sure that grows and does well. I also do all the grounds maintenance at the hospital, take care of the annual flower planting throughout the hospital and the three water features and a pond we have. I’m doing things with the Green Team too, dealing with recycling and our green projects.”

Why did you become a horticulturist?“I grew up with my parents owning a greenhouse so I’ve always been in the business a little bit. I’ve always enjoyed plants and working with them so I decided to go to school and got my degree in horticulture. I’ve been working in the field ever since and that’s been about 30 years now.”

how would you describe your perfect day at work?“To come in and everything would be perfect. There wouldn’t be any problems with my plants, no insects, no dry weather and it would be a nice day after a little rain.”

What do you find most rewarding about your job?“When people come up to me when I’m in front of the hospital working and tell me how great the place looks, how beautiful it is and what a good job I’m doing. That’s the best reward I could have.”

What’s your favorite plant and why?“That’s a tough one, I have a lot of them. I’m going to say the hydrangeas because they are such a diverse group. There are lots of different colors, and they can go from different environmental conditions really well and have a long blooming period. They’re just a real neat group of plants.”

how would you describe yourself?“Pretty easygoing, enjoy the outdoors immensely, like working with living plants, have a wonderful family and I’m pretty happy.”

What’s the biggest challenge you’ve overcome?“My father passed away at a young age, and I had to work through that. I had a bunch of problems dealing with that but I had a lot of help from school, and I think it’s made me a better person.”

What do you like to do in your spare time?“My wife, son and I enjoy camping a lot, hiking, bicycling. Then our winter fun sport is downhill skiing. When the weather’s bad we just stay home. My son’s at an age where he likes to do lots of family stuff, so we do a lot of games and play on the Wii.”

if you won the lottery what would you do with the money?“I’ve thought about this a lot actually. I always wanted to start my own business doing something different, or I have a big family so I’d like to share it with them and make sure everyone is comfort-able. I’d like to travel to some warmer climates, too.”

MEET A MEMBERTEXT Katie stilP


chris augustianceo, baycare clinic

you recently were promoted to ceo. how did your duties change from cfo to ceo?“From the finance side, I was taking care of the business office, collections, accounting, purchas-ing. Now as CEO I have full responsibility for the operations of the company.”

did you always aspire to be the ceo?“I did. When I started out in accounting — my college degree was in managerial accounting — I always wanted to manage. As I moved up to the CFO role I had a desire to move to the CEO role just as a natural progression.”

What advice do you have for someone who aspires to be a ceo?“What I’ve tried to do is surround myself with smart people, listen to them and not be afraid to take a big chance.”

What part of your job do you enjoy most?“I enjoy being in the discussions that revolve around making the clinic better, improving our op-erations and the patient experience. That’s one thing that’s always been interesting to me, the involvement of talking through new projects and processes. One of the reasons I moved out of general accounting was because you do the same process month after month. I wanted to do something that was constantly changing. That’s why I like this role.”

What’s a typical day like for you?“Every day is different. Every meeting is different. Many days we might start at 7 with an early morning meeting with the physicians before they start practice, and then two or maybe three nights a week we’ll have evening meetings that go anywhere from 8 or 10 because physicians will want to see patients until 5 and we’ll have meetings after that. Some days are 12, 15 hours, and others there aren’t as many meetings.”

What did you do before joining baycare?“I was in the finance department at the Marshfield Clinic. My wife and I were both at the Marsh-field Clinic prior to coming to Green Bay about nine years ago. I lived in Green Bay until I was about 13 and then my parents moved to Appleton. My wife and I always wanted to stay in Wis-consin, and Green Bay was a good landing spot. It has more opportunities for our kids compared to Marshfield. We really didn’t want to end up in a larger Chicago, Milwaukee city.”

What’s the biggest challenge you’ve overcome?“The biggest one I’ve faced as an individual is I was diagnosed with cancer when I was 29 and went through two years of treatment. That’s one thing that made me focus on what was impor-tant and not to take anything for granted, and not be afraid to take any chances. I think it helped me from a professional standpoint because I wasn’t afraid to put my name out there and take on new responsibilities because I don’t feel there is anything I can’t do at this point.”

What’s your favorite thing about living in green bay?“I like the outdoors and access to the water, being close to up north — we have a cottage on a lake. I like having access to all the things you need — shopping, restaurants, entertainment, the Packers, the colleges, those types of things — but not having a long drive to get to the outdoor activities our family enjoys.”

TEXT Katie stilP


CHAMBER BRIEFS

advanceThe Advance Business & Manufacturing Cen-ter, located at 2701 Larsen Rd. in Green Bay, is pleased to welcome Giantseed Creative LLC, a web design and Internet marketing studio….The center also announces the graduation of another tenant, Angelus Retirement Village of Hobart LLC, who entered the business incuba-tor in early 2012 as the incubator’s first assist-

ed living service provider to use the incubator as the off-site property was being developed. Angelus Retirement Village now resides at 650 Centennial Centre Blvd., Hobart…The Advance Microloan program re-cently announced it was certified by the Small Business Administration (SBA) as an intermediary microloan and received $500,000 in funding from the SBA. Because of the federal nature of this funding, the SBA portion of the Advance Microloan program will now be available to businesses both in Brown County and throughout 11 additional coun-ties in Northeast Wisconsin: Brown, Manitowoc, Outagamie, Calumet, Shawano, Oconto, Kewaunee, Door, Florence, Forest, Marinette and Menominee. As a result, the program formerly known as the Advance Brown County Microloan program is now known as the Advance Mi-croloan program. Since its inception, the microloan program has is-sued loans of $520,000 to 12 businesses in the Brown County area. For additional information on the microloan program, contact Marianne Dickson, director of the program, at 920-496-2111.

GovernMent affairs The Public Policy Council heard Wisconsin Transportation Secretary Mark Gottlieb in August discuss a variety of new initiatives at DOT including the US-41 reconstruction and interstate conversion project, a new performance measurement system and a commission that will report next year on future transportation funding. The Council also approved signing on to a U.S. Chamber letter urging Congress to take action to avoid a year-end fiscal crisis. At its September meeting, the Council heard Political Consultant Mark Graul preview the November election. A variety of other local and federal issues of interest to business are also being tracked, and you can follow their progress in our monthly Public Policy News digest. Sign up at http://www.titletown.org/communica-tions/chamber-newsletter-signup... A new quarterly public policy box lunch series, Let’s Wrap! premiered on Sept. 17 with a U.S. Chamber briefing on labor issues every employer should know...The issue of BBJ you are holding features a variety of articles on the local impact of the Af-fordable Care Act with contributions from members coordinated by the government affairs staff in cooperation with our com-munications department…The Good Gov-ernment Council spent July and August re-viewing voting scorecards on incumbents and interviewing a variety of national and state candidates in the November election.

Profiles of selected candidates were prepared and recommendations for endorsement were sent to the Chamber board and accepted for ratification at its late September board meeting…The Northeast Wis-consin Chambers Coalition continued work on a shared Legislative Agenda for 2013 to be approved by the six Chamber boards in time for the January start of the next state legislative session...A NEWCC-sponsored October briefing on the new national surface transportation law will feature two area congressmen, Reid Ribble and Tom Petri, who were architects of the bill…Municipal CEOs, administrators and fire chiefs from the four communities pursuing metro fire service under the Ritter Forum on Public Policy’s report A Shared Vision: Metro Fire Department selected a national consultant to develop a consolidation implementation plan. They also gave tentative approval to a plan to share cost and apply for grant funding at a Ritter Forum held Aug. 8…The Bay Area Community Council formed working groups to follow up on the Brown County 20/20: Envisioning the Future conference held earlier this year that debated and prioritized strategies in response to the findings of the LIFE Study (www.lifestudy.info) about local quality of life issues. The conference report and five commentary articles can be found at bayareacommunitycouncil.org. Community members are invited to participate in the working groups set up to pursue some of the most promising ideas developed at the conference.

leadership Green BayThe Leadership Green Bay Class of 2013 kicked off with its Welcome Breakfast on Tuesday, Sept. 11, with these individuals on the class roster: Rebecca Afshar, ITT Technical Institute; Ni-cole Allen, Nicolet National Bank; Keri Bak-ken, UnitedHealth care; Kate Bartell, Bellin

Health Solutions; Gina Bortel, St. Norbert College; Andy Braatz, Sadoff Iron & Metal; Rob Carviou, Prevea Health; Jenna Clevers, Davis & Kuelthau; Ryan Cook, Schreiber Foods Inc.; Lori Cuene; Kellie Diedrick, St. Vincent Hospital; Kati Donaho, Johnson Bank; Claire DuPont, The Marq; Roger Galler, St. Vincent Hospital;

Leadership Green Bay Class of 2013 kicked off at the Welcome Breakfast on Tuesday, Sept. 11.

Kristie Haney, PMI Entertainment Group; Christine Hilla, Wells Fargo; Jessica Hopp, Boys & Girls Club of Green Bay; Chris Howald, Tweet/Garot Mechanical; Josh Koch, Stellpflug Law S.C.; Steve Krueger, Liebmann, Conway, Olejniczak & Jerry S.C.; Vickie Lock, Northeast Wisconsin Technical College; Aaron Matthews, Integrys Energy Services; Rick Moericke, Schreiber Foods Inc.; Michelle Mulloy, Schenck; Mark Nicholas, PAi; Kyle Peterson, Ansay & Associates; Rebecca Pruess, American Foundation of Counseling Services; Dean Raasch, K&K Benefit Solutions; Len Rentmeester, Wisconsin Public Service Corpo-ration; Mary Rochon-Jewert, Associated Bank; Emily Rogers, University of Wisconsin – Green Bay; John Rousseau, Green Bay Police Department; Jaime Schumacher, Integrys Energy Group Inc.; Paul Simons, MCL Industries; Laura Smythe, Mediation Center Greater Green Bay; Dan Terrio, Green Bay Area Chamber of Commerce; Phil Turnbull, Prevea Health; Tracy Valenta, Green Bay Metropolitan Sewerage District; Tina Van DeVen, VSI LLC; Jenny Vande Leest, Hager, Dewick & Zuengler S.C.; Dean Weso-lowski, Georgia-Pacific Corp.; Adam Younk, Associated Bank.

MeMBer servicesNine-hundred forty-five people attended the Annual Welcome Back Packers Luncheon at the Lambeau Field Atrium on Aug. 29...The Chamber Ambassadors celebrated eight ribbon-cuttings in July and six in August. Many, many thanks to all the ambassadors – you are an amazing group!...Join us on Oct. 24, 2012, for the 130th Annual Dinner honoring our volunteers and featuring JR Martinez as our keynote speaker.

partners in educationThe Drug Alliance recently formed a partnership with Community Action for Healthy Living (CAHL) out of Appleton to begin work on tobacco aware-ness and health issues in Brown County. As part of this new partnership, the Drug Alliance endorsed

CAHL’s application for Transform Wisconsin’s transformation grant and will collaborate as part of the grant on tobacco usage and youth health…The Mr. Titletown Competition and Formalwear Fashion Show is being planned for Jan. 27, 2013, at the Radisson Hotel and Confer-ence Center. Last year’s event raised more than $5,000 for area high school post-prom parties and events…The Youth Apprenticeship pro-gram placed these students in August: Nicholas Miesler, Luxemburg Casco junior in the manufacturing/machining program will be training at M & M Tool and Mold; Benjamin Bouche, Green Bay Preble se-nior in the engineering program will be training at PDQ Manufactur-ing Inc.; Joshua Behling, De Pere senior in the welding program will be training at Valley Plating and Fabricating; and Mitchel Waniger, Green Bay Preble junior in the Engineering program will be training at KI… Dan Terrio, youth development program manager and man-ager of the Brown County Teen Leadership program, and Tad Taggart (West De Pere High School, Brown County Teen Leadership class of 2012) appeared on FOX 11’s Good Day Wisconsin morning show on Aug. 31 to discuss the program. Also, Emily Charneski (De Pere High School) and Sam Bald (West De Pere High School) appeared on NBC 26’s Partners in Education spot regarding their time with the program.


U.S.P.S. STATEMENTSTATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION OF THE BBJ

CHAMBER NEWSgo to www.titletown.org for the latest uPdates in chamber neWs and eVents

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➜ The Chamber hosted a ribbon-cutting for the Les & Dar Hobbit House Restroom at the Green Bay Botanical Garden on Aug. 13.

On July 12, Captain’s Walk celebrated its expansion with a ribbon-cutting. Pictured are Brad Schmiling (in front with his hands on the top part of the scissors) and Aric Schmiling.

Chamber Ambassador Deanna Novak, National Railroad Museum, proudly escorts Aaron Rodgers to his designated table at the Welcome Back Packers Luncheon on Aug. 29.

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Front row left to right: Carol Lagerquist, University of Wisconsin-Stevens Point; Becki Starry, Shorewest Realty; Joleen Allard, Green Bay Area Newcomers & Neighbors; Dr. Martin Hazuka, ProCare Chiropractic; Ivan Alvarado, Dr. Ray Roddan, ProCare Chiropractic; Dr. R. Susan Hensley, ProCare Chiropractic; Jessica Wilke, ProCare Chiropractic; Dawn Wagner, ProCare Chiropractic; Marilyn Kaczmarek, Wendy Willems; Quick Signs, Sue May, Heartland Business Systems/Avastone Technologies; Amy Hobbins, Journeys Unlimited Travel; Ann Ross, D1 Green Bay; Linda Bergman, ProCare Chiropractic; Mike LeMay, WORQ - Q90 FM; Jacquelyn Wilson, A Better You; Carrie Highfield, ProCare Chiropractic; Dave Racine, Yang Insurance and Jacqueline Smith, Airport Settle Inn celebrate ProCare Chiropractic’s ribbon-cutting on Aug. 17.


➜ The National Railroad Museum bid a temporary farewell to the Eisenhower Train on July 18; it left for England for repairs. Pictured are (background) National Railroad Museum Board of Directors President Paul Koch; Daniel Liedtke, operations manager/curator of collections; and Jacqueline Frank, executive director.

Chad Heath, account executive, Alliance Insurance Centers LLC (and Current’s new steering committee chair), and Joe Prosser, specification writer, LaForce Inc., enjoy a Current Lunch n’ Learn.

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The Advance Microloan program celebrated receipt of $500,000 for its program from the Small Business Administration on Aug. 20. Pictured are (left to right): Eric Ness, district SBA director of Wisconsin SBA district office; Marianne Markowitz, regional SBA administrator, Midwest Regional Office; Marianne Dickson, director of the Advance Microloan program, and Fred Monique, vice president of Advance, the economic development division of the Green Bay Area Chamber of Commerce.

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Visit cellcom.com for a complete listing of all retail and agent locations.Offer valid while supplies last. See Cellcom.com for details. Trademarks and tradenames are the property of their respective owners.

1.800.236.0055 www.cellcom.com Any Retail Locationfacebook.com/cellcom

Cellcom Retail Locations2066 Central Dr., Suite D, Bellevue 1580 Mid Valley Drive, De Pere Bay Park Square Mall, Green Bay

(920) 617-7400(920) 617-7800(920) 617-6565

4G LTE service available in select markets. Compatible device and data plan required. Average download speeds while on the 4G LTE network are 5-12 mbps. Other restrictions may apply. See store for details. LTE is a trademark of ETSI. Trademarks and tradenames are the property of their respective owners.

Life in the LaneFAST

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Green Bay Area Chamber of CommerceP.O. Box 1660 300 N. Broadway, Ste. 3AGreen Bay, W

I 54305-1660

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BBJ October/November 2012