WPS Health Solutions' History
Saluting the past, embracing the future
WPS in the 1940s
WPS' roots are strongly connected to events surrounding the Great Depression, World War II, and the postwar years, which contributed to transformations in medical care practices.
The costs of illness and medicine became critical government concerns because of the implications for social welfare, overall economic efficiency, and political conflict. The Great Depression exposed the financial insecurity of the nation's hospitals, encouraging hospitals to turn to health insurance for a solution to financial problems.
Beginning in 1935, the Roosevelt administration undertook Cabinet level actions to formulate a national health program, including recommendations for compulsory health insurance.
Medical community resistance, labor and business opposition, and a shift of political power in the 1938 elections helped terminate recommendations for a national health program. From 1943 to 1946 and during the 1948 presidential campaign, proposals for compulsory health insurance were again at issue in Congress. Again, the issues failed.
THE WISCONSIN PLAN
THE WISCONSIN PLAN
In 1935, the Wisconsin State Legislature authorized the State Medical Society to establish nonprofit insurance plans for sickness care. The State Medical Society then enacted a goal to develop a nonprofit insurance plan that would help those having difficulty paying for necessary health care. This led to the 1945 authorization of an insurance product that became known as the Wisconsin Plan.
The Wisconsin Plan collected low monthly premiums. It guaranteed payment for physicians' services if physicians accepted a set fee as full payment when treating Wisconsin Plan participants. This “full payment" provision reflected the Medical Society's conviction that Wisconsin residents should have the opportunity to budget costs for health care.
In 1946, the State Medical Society's House of Delegates established Wisconsin Physicians Service (WPS) as a division of the State Medical Society to market and administer the Wisconsin Plan and to develop other innovative methods of health care financing.
WPS' EARLY DEVELOPMENT
WPS' EARLY DEVELOPMENT
In 1943, the Milwaukee County Medical Society enacted the Surgical Care insurance plan, which became the first Blue Shield plan in Wisconsin. When WPS began operations in 1946, the State Medical Society challenged the Milwaukee County Medical Society's authority to sell Surgical Care insurance statewide. The State Medical Society then instructed the Milwaukee County Medical Society to merge Surgical Care operations under WPS' charter. Following American Medical Association arbitration, the State Medical Society accepted Blue Cross as the sales, billing, and enrollment agent for WPS operations.
WPS operations were excluded from Milwaukee County; the Milwaukee County Medical Society agreed to restrict its Surgical Care insurance plans to Milwaukee County.
AMA AND BLUE SHIELD ENDORSEMENTS
WPS proved itself as a successful and respected health insurance provider for groups and individuals through the development, marketing, and administration of plans across Wisconsin during the late 1940s. Two events punctuated WPS' success and helped accelerate its rapid market penetration:
- In 1948, the American Medical Association (AMA) awarded WPS the AMA Seal of Acceptance.
- In 1950, WPS became affiliated with the Blue Shield Association and was granted the right to use the Blue Shield symbol and trademark.
WPS in the 1950s
The 1950s were years of strong growth for WPS. The corporation began the decade as a major insurance provider for physicians' services and would end the decade as a major insurance provider for hospital services as well. WPS proved itself a leader in the development of new health insurance products and markets.
In January 1947, WPS had 1,042 insured persons enrolled. Within five years, enrollment multiplied to 216,000. Over the next five years, enrollment in WPS plans continued to climb from 248,000 in 1952 to 354,000 in 1957.
In 1957, WPS' sales force assumed full responsibility for the sale of WPS products and market development. Claim payments totaled $89,562 in 1947 and escalated to nearly $4.4 million by 1957.
In 1950, WPS moved its operations from Milwaukee to Madison, Wis. Regional and district sales offices were established to support WPS' growth. The first to open was a sales and service office in Kenosha in 1956, followed by similar offices in Eau Claire and Green Bay in 1957.
COMPUTER AGE BEGINNINGS
COMPUTER AGE BEGINNINGS
In 1952, WPS installed computer equipment for the first time to perform claims and statistical functions. From this simple beginning, WPS has become a significant owner and operator of computer hardware and software systems.
THE SPECIAL SERVICE PLAN
THE SPECIAL SERVICE PLAN
During the early 1950s, WPS adapted to meet changes in Wisconsin's health care delivery system. There were changing requirements for health insurance products and rising income levels that eventually made the Wisconsin Plan and its fee schedules outdated.
Responding to this challenge, WPS set and achieved a demanding corporate objective by developing a new kind of health care reimbursement—the Special Service Plan. The plan included an innovative kind of health care reimbursement done on a usual, customary, and reasonable (UCR) basis. UCR started with us and would soon become the national standard for all insurance companies!
OTHER PIONEERING EFFORTS
OTHER PIONEERING EFFORTS
In 1956, WPS began financing major medical or catastrophic health care expenses that could seriously disrupt a family's income. WPS offered an improved benefit option through the integration of Special Service and major medical contracts. These contracts continued to provide "first dollar" coverage for a wide variety of medical procedures. They also allowed a high ceiling of coverage for prolonged, catastrophic medical expenses.
RURAL WISCONSIN EXPANSION
RURAL WISCONSIN EXPANSION
In the early years, WPS learned the importance of close attention to local needs and local service. WPS offered group rated health insurance for independent farmers affiliated with dairy, creamery, and cheese plants.
To better serve these rural markets, WPS developed regional sales and service offices, which continue to play a vital role in WPS' efforts to provide comprehensive local service and superior performance throughout the state.
WPS was among the first Blue Shield Plans to offer independent agents the opportunity to represent WPS in the marketing of its health insurance plans.
In 1957, the WPS sales force was established, including the first agency contract. By 1963, the number of contracted agencies climbed to 176.
CONTINUED BUSINESS EXPANSION
CONTINUED BUSINESS EXPANSION
Throughout the 1950s, WPS proved itself as a leader in health care financing, developing fresh approaches to the needs of Wisconsin residents:
- WPS developed an improved health care financing program for migrant workers.
- WPS successfully arranged for employees covered by a WPS group plan to make premium payments through payroll deductions.
- WPS also launched a health insurance plan for individuals who leave their employment and therefore lose group health insurance. The new plan allowed these individuals to convert from group health insurance to individual insurance.
MILITARY MEDICARE: CHAMPUS BEGINNINGS
In 1956, the Department of Defense named WPS as the Wisconsin contractor for "Military Medicare," which later became known as CHAMPUS, (the Civilian Health and Medical Program of the Uniformed Services), and which is now known as TRICARE.
This began a long WPS tradition of more than 40 years of high-quality claims administration services for CHAMPUS and other federal government health benefit programs. Today, WPS is committed to effective and timely corporate support of our TRICARE line of business. WPS offers important technical advantages for secure service and performance leadership in accomplishing TRICARE objectives.
WPS in the 1960s
The 1960s were an interesting time. It was the height of the Cold War, punctuated by the Bay of Pigs invasion and the Cuban Missile Crisis. After that, the Vietnam War, civil rights protests, hippies sharing peace and love, and the first moon landing. From The Beatles to Gilligan's Island to muscle cars, there were new things everywhere.
Wisconsin Physicians Service was busy with many new things as well. WPS developed new programs, new innovative coverage, and new ways to streamline claims administration. There were new offices, as WPS expanded by opening offices in Milwaukee in 1962 and in Wausau in 1965. The company also added the new IBM 1440 to its operations—a prototype of today's computer. WPS was a powerful force in Wisconsin's health insurance industry.
STATE OF WISCONSIN CONTRACT
In 1960, just two years after making a break from Blue Cross of Milwaukee, WPS met and achieved a significant sales objective by winning a contract to cover the surgical/medical portion of the State of Wisconsin employee benefits program. For 28 of the next 34 years, WPS insured or administered all or part of the State of Wisconsin Health Benefits Plan.
CARING FOR OLDER AMERICANS
Throughout the 1960s, continuing advances in medicine enabled Americans to live longer than ever before. Those nearing or reaching retirement age could reasonably expect to live happy and useful lives well beyond retirement. These years could be more secure once the threat and burden of overwhelming medical expenses were removed. WPS recognized the challenge and opportunity to provide insurance coverage tailored to older Americans.
WPS developed and marketed the Century Plan for those over age 65 beginning in 1960. The Century Plan was a single package policy with benefits covering physician and hospital services plus limited nursing home care. This plan represented another innovative health insurance approach and placed WPS among the leaders in designing, marketing, and administering health benefits plans. As with Special Service Plan benefits, Century Plan benefits were paid directly to the physician, hospital, nursing home, or other provider of care.
WPS had already been caring for seniors for five years when the Medicare bill passed in 1965. With the implementation of the federal Medicare program in 1966, WPS became the Part B (physicians services) administrator for Medicare beneficiaries in Wisconsin, except for Milwaukee County, which was a separate Medicare service area.
Because Medicare provided only partial health care protection, WPS again took the initiative and developed a supplemental Medicare policy. This first Medicare supplement insurance was based on valuable experience gained from administering the Century Plan. Called Medicare-PLUS, it offered coverage to fill some of the gaps left by the Medicare program.
NEW INDIVIDUAL HEALTH PLAN OPTIONS
In this decade, WPS developed and tested the Ready Reserve Plan. The Ready Reserve Plan was WPS' response to the need for individual major medical insurance. It was designed to help cover the expense of a prolonged illness or major surgery.
For the younger family, WPS also developed an age rating system through which insurance protection could be offered at low initial rates that increased with age and the subsequent ability to pay higher premiums.
WPS also developed supplemental coverages for prescription drugs, dental care, vision care, miscellaneous illness, and home care.
Then Apollo 11 landed on the moon. The Woodstock music festival took place. And we moved into the 1970s.
WPS in the 1970s
As tie-dye gave way to denim and earth tones, America experienced massive inflation. Everyone was looking for ways to save money. Technology was advancing rapidly, first with hand-held calculators, then microprocessors, then the first video game to have commercial success—Pong. This is the decade that saw the fall of Richard Nixon, the end of the Vietnam War, and the birth of “Saturday Night Live." WPS was taking all the changes in stride.
A NEW PLAN TO HELP GROUP CUSTOMERS SAVE MONEY
After careful study and planning, Wisconsin Physicians Service created a new plan—the Health Maintenance Program—in 1970. Started as an experiment in Wild Rose, Wis., HMP was an “open panel" prepaid group health plan. The open panel feature allowed enrolled individuals to retain, in most cases, the freedom to visit the physicians of their choice.
HMP included all the traditional benefits of health insurance plans, plus coverage for most basic or primary health services, such as office calls, well baby care, and immunizations. Its intent was to help control minor illnesses before they become major ones.
As the state's medical community and health care consumers came to recognize the positive features of HMP, the program experienced substantial growth. In March 1971, Green County signed on as the first county wide customer. Any employed group with 10 or more employees was eligible for enrollment.
In 1974, four years after the original experiment in Wild Rose, there were more than 69,000 insured people enrolled in HMP in 25 counties throughout Wisconsin.
SAVING MONEY THROUGH APPROPRIATE CARE
The early 1970s were turbulent years for the nation's health care system. A perceived overemphasis on high technology and illness oriented care was thought to be responsible for rising health care costs. As a result, the private health care sector experienced increasing pressure from government agencies to respond.
So, WPS moved decisively during the decade to provide strong local, regional, and national leadership to address preventive care and cost containment concerns. For example, in May 1973, WPS implemented Health Services Review operations to review and monitor the utilization of health care services. Then, in 1976, WPS began service relationships with Professional Standards Review Organizations, or PSROs, which used statistical analysis of hospital discharge data to set guidelines on appropriate care for hospital patients with specified medical conditions.
THE FIRST ASO CONTRACT
In the early 1970s, Wisconsin Physicians Service entered into its first cost plus agreement with a private employer, quoting its first Administrative Services Only (ASO) bid. Today, ASO contracts are still important, and WPS is still creating new partnerships to serve ASO customers better.
BROADWAY BUILDING CONSTRUCTED
In November 1973, WPS moved operations to a newly constructed corporate headquarters facility at 1717 West Broadway in Monona, bordering Madison's south side. Computer and accounting functions remained at the former East Lakeside Street facility in Madison until January 1978.
COMPUTER SYSTEMS UPGRADED
WPS upgraded computer capabilities by installing terminals in the Claims Department in July 1970.
In December 1977, WPS installed an IBM 370/148 Central Processing Unit (CPU) at the East Lakeside Street facility with a 2 MB memory that increased computer capacity fourfold. WPS Systems and Programming personnel developed the initial prototype software. Since that time, WPS has progressively updated and modified the software to keep pace with increased claims volume and new system requirements.
In November 1978, WPS increased computer capacity by 50% to 3 MB of memory with a new IBM 3031 CPU. The following year, another 3 MB of memory were added.
GOVERNMENT CONTRACTS GREW
In August 1979, the Health Care Financing Administration terminated the Milwaukee County Medicare Part B contract (which had been separately administered by another contractor) and added the Milwaukee service area operations to WPS' contract. This change was made because of WPS' proven cost effectiveness in Medicare Part B claims processing and excellent record as a Medicare Part B contractor.
In October 1979, WPS developed and implemented a paperless claims processing system for the Medicare program. WPS Medicare operations also made extensive use of optical character recognition (OCR) technology to scan claims not submitted through electronic data interchange (EDI). Today, Medicare claims are still received through EDI or OCR.
In the late 1970s, WPS set and achieved a demanding objective to obtain Department of Defense CHAMPUS contracts covering states other than Wisconsin. These efforts produced contract awards in Kansas, Oklahoma, Indiana, Kentucky, and Illinois, and positioned WPS for even stronger growth in the early 1980s.
On April 27, 1977, after 30 years as a division of the State Medical Society of Wisconsin, WPS became its own company, separately incorporated as Wisconsin Physicians Service Insurance Corporation.
The effort to separately incorporate began a few years earlier. In 1975, the Wisconsin legislature passed a law requiring service insurance corporations to be legally separate from their parent professional society. Accordingly, on April 17, 1977, following the enactment of Chapter 613 of the Wisconsin Statutes, WPS was incorporated as a nonprofit and nonstock service insurance corporation. The transfer of employees from the State Medical Society payroll to the WPS payroll, along with most assets, took place in June 1977.
The first President of the new Wisconsin Physicians Service Insurance Corporation was Ray Koenig. As WPS moved into the 1980s, it was primed for even more success.
WPS in the 1980s
I want my … I want my … I want my MTV. During the 1980s, conservative politics and Reaganomics held sway as the Berlin Wall crumbled, new computer technologies emerged, and blockbuster movies and MTV reshaped pop culture. This was the decade of space shuttles, the Iran-Contra Affair, AIDS, the Chernobyl nuclear disaster, and neon clothing of all kinds.
It was also a time of explosive growth for WPS. Legislative changes in Wisconsin during the early 1980s created a business environment that allowed free market forces to play a greater role in health care delivery and financing. WPS was strongly positioned to take advantage of these developments.
NEW HEALTH PLANS
WPS developed alternate health delivery plans that ranged from group health incentive plans and independent practice association Health Maintenance Organization (HMO) plans to Preferred Provider Organization (PPO) plans.
WPS administered HMOs, PPOs, and other alternate health delivery plans, including Q Care, an HMO with Gundersen Clinic in La Crosse, Wis. Q-Care served nine west-central Wisconsin counties, along with the neighboring counties in Minnesota and Iowa. The WPS AllHealth HMO plan served southern Wisconsin and northern Illinois.WPS also marketed and administered Physicians Plus Preferred, the only PPO in Dane County at the time. The Physicians Plus plan featured group comprehensive major medical insurance designed to retain participants' freedom to choose physicians with a low-cost managed care alternative. Participants could choose to receive care from any health care provider, or for a lesser cost, receive care from Physicians Plus Medical Group and Meriter Hospital.
WPS continued its commitment to effective and timely corporate support of the CHAMPUS line of business. In 1981, in a highly competitive national procurement, the Office of CHAMPUS awarded WPS the first regional CHAMPUS Fiscal Intermediary contract to process claims for the CHAMPUS South-Central Region, which included Arkansas, Kansas, Louisiana, Missouri, Oklahoma, and Texas. This contract more than doubled WPS' CHAMPUS claims volume.
In 1984, also in a highly competitive procurement environment, WPS won a second major contract for the CHAMPUS Mid Atlantic Region, which included Delaware, Maryland, North Carolina, Pennsylvania, South Carolina, Virginia, and the District of Columbia.
In subsequent competitive procurements, the Office of CHAMPUS selected WPS in 1984 and 1987 as the best-qualified company to administer successor contracts for the CHAMPUS South-Central Region.
Then, in 1989, the Office of CHAMPUS awarded WPS the contract for the Southeastern Region, which included Alabama, Florida, Georgia, Mississippi, Tennessee, and all foreign countries.
Today, WPS functions as the prime contractor for TRICARE For Life and is a subcontractor for both the TRICARE Overseas Program and TRICARE Managed Care Support for the East Region. WPS is well respected for its work on TRICARE plans because of its vast knowledge of CHAMPUS/TRICARE operations, claims processing technology, and long-standing relationship with the Department of Defense.
With the award of the CHAMPUS South-Central Region contract in 1981, WPS moved quickly to allocate resources for an additional facility at 1617 Sherman Avenue in Madison, Wis.
In 1982, WPS constructed a new corporate headquarters—the Ray Koenig Building (pictured at right)—at its Monona location. Continued growth required placing selected facility operations in leased office space in other Madison area locations.
WPS broke ground in the spring of 1988 for a major new office building with over 153,000 square feet of floor space near our Monona location. The project, called the Engel Building (pictured below), included a three level parking ramp with an enclosed connecting tunnel. The new building was designed with a view to the future. In the event additional office space was needed, another building module of the same size and exterior shape could be joined to the building. The structure was completed and dedicated by a formal open house in September 1989. It was later renamed the Nordby Building. The building and its connected parking ramp were sold to One City Schools in 2021.
NEW COMPUTER SYSTEMS
In October 1986, WPS installed an IBM 3084QX. The IBM 3084QX provided 64 MB of memory and was rated at a capability of 32 million instructions per second (MIPS).
In November 1988, WPS installed a second mainframe computer, an Amdahl 5880, with 64 MB of memory, to provide full backup for the IBM 3084QX computer and double the CPU capacity.
WPS relocated the corporation's computer facilities to the new Ray Koenig Building and continued to update and improve computer system operations in the 1980s.
In the 1980s, sales operations again expanded in Wisconsin when WPS opened sales and service offices in Appleton in 1980 and in La Crosse in 1985.
WPS' expanded operations in all lines of business required an increase in the number of employees from approximately 700 in the late 1970s to more than 2,500 by 1989.
WPS CUTS TIES WITH BLUE CROSS AND BLUE SHIELD ASSOCIATION
While WPS was aggressively pursuing a philosophy of greater free enterprise competition in the marketing of products and services in Wisconsin and other states, the WPS Board of Directors undertook a review of the affiliation with the Blue Cross and Blue Shield Association.The WPS Board concluded there were a number of critical ways in which WPS corporate interests and objectives were no longer consistent with those of the Association. By 1985, the interests of WPS and the Blue Cross and Blue Shield Association had diverged considerably, and WPS terminated its affiliation with the Association.
The 1980s and early 1990s also saw the diversification of WPS lines of business. Active subsidiaries in the 1980s included:
- Administrative and Technical Services, Inc. (adtec), established in 1979, provided a variety of office services.
- InsurTec, established in 1982.
- The EPIC Life Insurance Company, which was developed in 1984 to sell and administer life and disability insurance in select states across the nation.
Additionally, WPS established the Ray Koenig Foundation of WPS, Inc. in 1986. Today, this Foundation is known as the WPS Charitable Foundation. It continues to support children of WPS employees with scholarships, as well as selected charities.
The second President of Wisconsin Physicians Service Insurance Corporation was Mahlon Bontrager. Mahlon took the helm in 1986 and served until 1992. As WPS moved into the 1990s, it was in a period of growth.
WPS in the 1990s
In music, grunge and hip hop took off. In the Middle East, the Gulf War flared up. The internet was becoming broadly available to anyone using Netscape Navigator or Internet Explorer. Bombings at the World Trade Center and the federal building in Oklahoma City awakened us to domestic terrorism. The North American Free Trade Agreement, or NAFTA, was passed. And the United States experienced great prosperity as the Soviet Union collapsed.
FOCUSED ON MANAGED CARE
The 1990s were a highly competitive period for businesses. WPS continued to develop innovative products and expand its managed care operations, including fostering partnerships with some of the most outstanding health care providers in the state.
The popular WPS Preferred Advantage plan was a preferred provider organization plan that featured high-quality provider partners serving all areas of Wisconsin, including Dean Clinics and St. Mary's Hospital, Marshfield Clinic, Aurora Healthcare, and United Preferred, among others. The plan offered employer groups a choice of deductibles, coinsurance, and out of pocket levels. The managed care features used WPS' own Value Care Review, a care management program featuring individual case management, preadmission review, and utilization review.
WPS also developed two point-of-service plans: WPS POS and AllHealth. AllHealth served southeastern and northeastern Wisconsin residents, while WPS POS was primarily focused in the Milwaukee area and southeastern Wisconsin. Both plans offered gatekeeper features in which a primary care physician (PCP) monitored participants' care and guided them through the health care delivery system. Customers also had the freedom to choose out of network providers at higher out of pocket costs.
Another part of the WPS benefit plan portfolio was the Care Share Plan, or CSP. CSP featured the traditional indemnity type comprehensive major medical protection, with flexible deductible and coinsurance options. CSP also offered freedom to choose physicians and hospitals yet incorporated proven cost management strategies to discourage overutilization of services.
WPS also created an Individual Preferred Provider Plan, offering managed care features and networks of providers to Wisconsin's individuals and families. Individuals could also choose the Instant Protection Plan, a short term major medical plan intended for those between jobs or just out of school.
A CHAMPION OF CHAMPUS
In 1990, WPS was awarded a $20 million U.S. Department of Defense contract. The new contract resulted in 500 new jobs, which required the renovation of the Park Street facility to house more of the CHAMPUS operations.
In the early 1990s, WPS developed its own proprietary claims processing system, which allowed WPS to be one of a handful of companies nationwide that could handle military data. This capability allowed WPS to win several large contracts to administer claims on behalf of larger prime contractors such as Humana and TriWest.
NEW PRESIDENT AND CEO
In 1992, James (Jim) Riordan was named the third President and CEO of WPS. There are more than 220 current WPS employees who started working at WPS in the 1990s who may remember Jim's early years at the helm.
In June 1995, WPS partnered with ProVantage, a Milwaukee-area pharmacy benefits manager, to provide more competitive services.
In May 1996, a new partnership with Delta Dental of Wisconsin was created. This allowed WPS to offer a full range of group dental products to its group health plan customers.
A DIVISION FOR SELF-FUNDED GROUPS
Early in 1997, WPS changed course, using the InsurTec name to exclusively service the needs of self funded clients. InsurTec helped WPS successfully compete with the ever growing number of third-party administrators in this market.
InsurTec had the flexibility to use multiple vendors in a variety of health markets to provide clients with a “best fit" benefit plan. Vendors could include managed care programs, provider networks, or reinsurers. InsurTec looked to WPS to provide these options, but the freedom to shop around provided InsurTec with the ability to satisfy a wide variety of potential customers.
CONSOLIDATION AND TRANSITION
In 1998, WPS brought all three major lines of business together on its Monona campus. For the first time, Medicare, TRICARE, and commercial business lines were all headquartered in the same place.
Also in that year, WPS took on the Medicare Part B workload for Michigan and Illinois. This was the largest Medicare transition in history at the time, and WPS managed it flawlessly. It made WPS the largest Part B carrier in the nation, serving more than 3.6 million Medicare Part B beneficiaries. WPS processed more than 21 million Part B claims in 1998.
BUSINESS OF THE YEAR
In 1999, WPS was named Business of the Year by both the Greater Madison Chamber of Commerce and the Greater Marion (Ill.) Chamber of Commerce.
WPS in the 2000s
The buildup to the year 2000 featured a fear of a Y2K computer glitch that could cause a disaster. Fortunately, not much happened when the calendar rolled over to the new millennium. However, 2000 was an active year as terrorists linked to Al-Qaeda used 400 lbs. of explosives to bomb the USS Cole off the coast of Yemen. Mad cow disease was causing alarm in Europe. Russell Crowe starred in “Gladiator," which won the Academy Award for Best Picture. And WPS kept churning forward with new products and new contracts.
MEDICARE BUSINESS BOOMS
In May 2000, WPS held grand opening ceremonies for its new $4.7 million Medicare office in Marion, Ill. (pictured at right). The same year, WPS won the Medicare Part B contract for Minnesota.
In 2005, WPS and Mutual of Omaha announced the acquisition of Mutual of Omaha's Medicare Part A division. Under this agreement, Mutual of Omaha's Medicare Part A division was transferred to WPS. This facilitated WPS competing for the new MAC regions, which required combined Part A and Part B administration. Previously, the Centers for Medicare and Medicaid Services (“CMS") awarded separate Part A and Part B contracts by state. In 2006, WPS also acquired Mutual of Omaha's government claims business.
In 2007, WPS was awarded the Medicare Part A and Part B MAC Jurisdiction 5 contract, covering Part B benefits for Iowa, Missouri, Kansas, and Nebraska, plus Part A benefits in 47 states. WPS still holds this contract today.
HEALTH INSURANCE GROWS
In 2001, WPS assumed the contracts of 45,000 people insured by North Central Health Protection Plan, moving WPS into the top 10 health insurers and administrators in Wisconsin. In 2001, Medco Health purchased ProVantage and became the official pharmacy partner of WPS.
WPS was again at the forefront in 2006 when it launched a new Medicare Prescription Drug Plan, or PDP. These new Medicare Part D plans were a result of the Medicare Modernization Act, which was signed into law in 2003. PDPs helped make prescription medications more affordable for Medicare beneficiaries.
In 2005, WPS bought the assets of Prevea Health Plan, which was based in Green Bay, Wis. Then, in 2006, WPS renamed it Arise Health Plan and began offering Health Maintenance Organization (HMO) and Point-of-Service (POS) plans to customers in eastern Wisconsin. The Arise name lasted until it was retired in 2020.
TRICARE TAKES OFF
In 2001, WPS began processing claims for the new TRICARE For Life program. This workload enhancement included the hiring of more than 450 additional employees. WPS also added 80,000 sq. ft. of leased office space on Madison's northeast side as it began development and construction of a new building on its Monona campus. The new building, dubbed the Corporate Center (pictured at right), was completed in September 2002.
In 2003, WPS was awarded the TRICARE Dual-Eligible Fiscal Intermediary Contract (“TDEFIC") to provide claims processing, customer service and administrative services to more than 1.7 million individuals eligible for both TRICARE and Medicare, beginning April 1, 2004. Also in 2003, TriWest HealthCare Alliance won the TRICARE West Region contract; WPS administered claims as TriWest's subcontractor. Additionally, in 2003, Humana Military Healthcare Services was awarded the TRICARE South Region contract, and WPS administered claims as Humana's subcontractor. These two contracts covered more than 2.6 million members of America's military.
WPS ended the decade well positioned to take on the 2010s.
WPS in the 2010s
As America was recovering from the Great Recession of 2007–2009, social media was taking off. It fueled movements such as Occupy Wall Street and Black Lives Matter. School shootings caused concerns in Newtown, Conn., Parkland, Fla., and many other communities. Same-sex marriage became legal in 18 countries, including the United States. Smartphones became ubiquitous. Minecraft was a hugely popular videogame, and Fifty Shades of Grey was the best-selling book. At WPS Health Solutions, the 2010s were a decade of accolades, contract ups and downs, and trying new things.
In 2010, WPS was named one of the World's Most Ethical Companies® for the first time by the international Ethisphere® Institute. The award followed in each of the next nine years, making WPS a 10-time winner of the award.
The WPS MedicareRx Plan, the Medicare Part D prescription drug plan (PDP) offered to seniors, earned 4.5 stars out of 5 from the Centers for Medicare & Medicaid Services (CMS) in 2011, making it the highest-rated plan in Wisconsin. In 2014, the plan did even better, earning a full 5 out of 5 stars!
WPS opened a new office in West Frankfort, Ill., in 2018 (pictured at right). In 2020, WPS was named Business of the Year in West Frankfort by the local Chamber of Commerce.
CONTRACT ROLLER COASTER
In 2011, WPS was awarded the Medicare Jurisdiction 8 contract, which provides Part B benefits for beneficiaries in Indiana and Michigan.
WPS was hit with big contract losses in 2012, when the TRICARE West Region contract and the Medicare Jurisdiction 6 contract were lost. The losses resulted in layoffs of about 650 valued employees.
WPS did not sit still, however. The next year, three new subcontracts for TRICARE put WPS in the position of administering benefits for nearly half the eligible veterans in the U.S. Then, in 2014, WPS was awarded the contract renewal for TDEFIC, which extended work on TRICARE For Life for an additional six years. In October 2014, work began on the Patient-Centered Community Care (PC3)/Choice contract for the Department of Veterans Affairs (VA).
A big contract win happened in 2018 when work began on the TRICARE East Region (in blue on map) contract, which meant WPS was processing claims for about 60% of the country's active-duty military and their families. Also that year, WPS partnered with TriWest Healthcare Alliance to take on additional work in support of the PC3 and Choice programs for the VA.
In 2018, WPS was again awarded the Medicare Jurisdiction 8 contract, this time for Part A and Part B benefits administration.
In 2019, CMS awarded WPS the Jurisdiction 5 contract, which includes the Part A and Part B workload for Iowa, Kansas, Missouri, and Nebraska, plus a national component. The same year, WPS was also awarded new subcontracts to support the VA Community Care Network Region 4 contract held by TriWest Healthcare Alliance.
TRYING NEW THINGS
In 2012, WPS got a new President and CEO: Mike Hamerlik. Replacing retiring President and CEO Jim Riordan, Mike set out to modernize WPS and refocus the company on what is most important for success. He is the fourth President and CEO since WPS was incorporated in 1977.
In 2013, WPS opened an on-site clinic at its Monona headquarters in partnership with QuadMed. After several years of lower-than-expected use, the clinic closed in 2017.
In 2016, WPS announced a new initiative with Aspirus, Inc. and created a new holding company, Arise Health Ventures. A new health plan, integrated with the health care provider, was born. Aspirus Arise began selling health plans in central and northern Wisconsin in 2017. To avoid any potential conflict of interest with federal contracts, however, WPS sold its stake in Arise Health Ventures to Aspirus in 2019.
WPS in the 2020s
COVID-19. Nothing so marked the beginning of the 2020s like the pandemic. Video streaming services were all the rage. Maybe you enjoyed the Tiger King. Maybe you caught The Queen's Gambit. There were orders to stay at home, wear face coverings in public, and to maintain social distancing. Travel restrictions kept more people at home. Attendance at state parks boomed. Among the chaos, everyone found new ways to do things differently. At WPS, we took it in stride, going remote without skipping a beat.
In March 2020, more than 93% of WPS employees began working remotely. As our work and social environments drastically changed, the Human Resources department gathered some tips to help employees. WPS created new procedures to help keep employees healthy and urged everyone to follow the guidelines set by the Centers for Disease Control and Prevention.
Due to so many employees working remotely, WPS made some changes to its footprint. The office in Hampton, Va., was moved to a smaller building. The office in Marion, Ill., was closed and employees moved to the nearby West Frankfort, Ill., office. Plans for new construction at the Monona, Wis., headquarters were put on hold. And WPS put the Nordby Building and the nearby parking ramp up for sale. The Nordby sale to One City Schools was announced in March 2021 and completed at the end of July 2021.
FOCUS ON DIVERSITY, EQUITY, and Inclusion
Amid social unrest around the country following the murder of George Floyd in Minneapolis in May of 2020, WPS moved forward with efforts to promote diversity, equity, and inclusion that year. In October, a new DEI Accountability Board was created. Then, in January 2021, WPS hired a new Vice President of Diversity, Equity, and Inclusion. By July, the DEI Accountability Board was renamed the DEI Employee Council. Also in July, a new DEI team was announced. The DEI journey was off to a strong start. The DEI Employee Council continues to provide an employee-centric perspective aimed at embedding diversity, equity, and inclusion into the systems, behaviors, and work done at WPS every day.
REBRANDING OF ARISE
In October 2020, Arise Health Plan, a subsidiary of Wisconsin Physicians Service Insurance Corporation, underwent a rebranding to become WPS Health Plan. More than 240 documents had to be updated by the Marketing team and separate websites had to be integrated into one.
WPS was awarded the TRICARE Medicare Eligible Program (TMEP) contract in April 2021. This contract win meant WPS would continue to serve more than 2 million TRICARE For Life beneficiaries for seven more years through April 30, 2028. WPS has served as the administrator for the TRICARE For Life program since its inception.
VETERANS AFFAIRS CONTRACTS EXPIRE
In March 2021, WPS signed a Wind-Down Agreement with TriWest after months of negotiations. In September 2021, work on the Veterans Affairs contracts was completed.
Kicking off 2020 in style, in January, WPS Health Solutions was named Business of the Year for 2019 in West Frankfort, Illinois, by the local Chamber of Commerce.
In September 2020, WPS received two awards from the Health Ethics Trust for its compliance efforts. In September 2021, WPS received another Best Practice Award.
In May 2020, the Marketing team won two silver Telly Awards for a veteran-focused video produced for WPS Military and Veterans Health. The team won another silver Telly Award in May 2021 for an animated commercial for WPS Health Plan individual insurance plans.
2021 and 2022 won a series of regional and national Top Workplaces Awards including special categories for Remote Work and Work-Life Flexibility.
WPS Health Solutions named a Top Workplace in the Madison area by the Wisconsin State Journal in March 2021. WPS employees voted to gain this recognition for the company.
In August 2021, WPS was chosen as one of the Achievers 50 Most Engaged Workplaces®. The award recognizes employers that put people first.
EMBRACING THE FUTURE
As WPS looks to the future, the return to the office everyone expected when the pandemic began has not happened. And it isn't expected to. WPS has changed once again, adapting to the changing needs of employees, the business, and its customers and beneficiaries. A new hybrid work model has emerged that allows some employees to work remotely, some to work in a WPS office, and some to do a little of both. As WPS continues to evolve, grow, and learn, more changes are inevitable. But our purpose remains constant—Together, making health care easier for the people we serve.
WPS CHARITABLE FOUNDATION
In 2020, the WPS Charitable Foundation established the scholarship to allow underrepresented students the opportunity to earn an insurance certificate through Madison College. The Urban League of Greater Madison worked with Madison College to enroll students in the 14-credit Insurance Certificate for the Business Professional program under full scholarships.
A second financial commitment of $25,000 to the Madison College Foundation from the WPS Charitable Foundation broadens the depth and breadth of WPS’ impact to more than a financial contribution.