Every time I hit the road to meet with people who are engaged with real reform of health care, I come away encouraged. They are bringing a wide range of innovations to bear on the out-of-control inflation that plagues the biggest sector in the U.S. economy.
On a recent visit to Charlotte, N.C., I exchanged lessons learned with the number two executive for one of the biggest health care systems in the country, a primary doctor contracted by employers in Wisconsin, and a private sector payer in charge of an $11 million spend for care at her company. They were unanimous in endorsing a return to a medical model based on pro-active primary care delivered right at the work site.
Joe Piemont, Dr. Suzanne Gehl and Rhonda Lockhart are in very different places in the care landscape, but they agree that the present model for the delivery of care is busted. They weren’t talking about the Affordable Care Act, which deals primarily with insurance reform. They’re talking about a new business and care model being developed in the private sector.
Piemont, president and chief operating officer of the Carolinas HealthCare System, which employs 61,000 people, told 150 business people in Charlotte, North Carolina, that the current model is “unsustainable.”
His question: “Why do we have this continuing and spiraling trend upward on health costs?”
His answer: “Health care has been mainly about rescue, and rescue is expensive.”
So he is leading his organization away from reactive care to proactive, from what he called “massive interventions” to holistic, long-term, relationship-based care that keeps people out of the hospital. Through an initiative called “Healthworks,” his system contracts with employers to put medical homes for employees right at the work site.
That enables intense management of chronic diseases, catching conditions early and keeping people out of hospitals, the opposite of filling beds for revenue sake. It hurts the hospital’s top line in the short run, but it’s the right thing to do in the long run. So Piemont could be viewed as a real reformer from inside the huge health care industry.
Nonetheless, leaders in manufacturing and other industries know that the biggest lever for pushing higher levels of performance comes from customers – from the outside.
Rhonda Lockhart and Dr. Suzanne Gehl are two such reformers, who are both delivering and promoting medical homes as a way to engage employees in their families’ health:
Lockhart is vice president of human resources at JM Smith Corp., the third largest employer in South Carolina with more than $1 billion in sales. Gehl is a primary care doctor who works on a contract basis for private employers in West Bend, Wisconsin.
JM Smith created an on-site health care clinic in 2004 with a nurse practitioner. It worked well, but the company wanted to do more for workforce health. So she added a part-time doctor to its contracted staff last year. That “really made a difference,” Lockhart said. “I have started to see a reduction in everyday claims.”
In effect she took back the front end of the medical supply chain: primary care. It’s employer-driven, proactive medicine versus a model that fixes you when you are broke. Some big health care systems, like Piemont’s, have diagnosed the economic writing on the wall and are contracting directly with private employers to provide on-site primary care.
Listen to Dr. Gehl. She said she couldn’t “do justice” to her patients when she worked in a big hospital system, seeing 12 patients in two hours, one every 10 minutes, including several full physicals. Now she has no more than 500 patients on her panel and see her patients for 30-45 minutes as necessary.
She cited recent examples of workforce health improvements and huge cost savings. One employee had a bad hand infection, which Dr. Gehl handled on an outpatient basis, saving “a boat-load of money.”
When she started in a “near-site” clinic in West Bend, where primary care is free to employees of several companies, she saw people who hadn’t seen a doctor in 10 to 12 years.
She guided one woman to a 100-pound weight loss, and, as a byproduct, her husband also lost weight, 35 pounds, and he stopped smoking to boot. In another instance, an employee had four family members with strep throat, so she made a house call instead of having the whole family visit her near-site clinic.
Dr. Gehl, who works for a nationwide franchise for concierge doctors, called Paladina, handles many cases at the primary care level that otherwise go to very expensive specialists. More than half the doctors in this country are specialists, about double the level in other countries. Guess why our nation’s health care bill is so high?
She orders the medical tests – judiciously, not as a revenue builder; she orders drugs – generics whenever suitable; she orders specialty care – only when necessary; and she orders hospital admissions. Private companies that are deploying the new model for care are seeing their hospital admissions drop by as much as half. Think about the savings at $25,000 or so for an average admit.
For proof of the effectiveness of the on-site primary care model, look to QuadGraphics, the nation’s second largest printer. Quad has been using an on-site clinic since 1990 and brings in care at 30% below the U.S. average. That success has led to QuadMed running more than 100 on-site clinics for large employers across the country.
There is a common denominator here for all businesses: Make workforce health a strategic priority, create a medical home for your people, and enjoy the savings that follow.