A grand state strategy: medical homes for all

If Wisconsin, or any other state, wanted to adopt an over-arching strategy for the health care of its citizens, there is a proven one available.

Private sector employers that have created medical homes for their employees have achieved remarkable improvements in workforce health and equally remarkable reductions in health care costs.
IBM, for instance, has made proactive primary care, delivered through medical homes, the centerpiece of its strategy on workforce health. The company claims, as a result, to have held its medical cost inflation to zero percent over the last decade.

Quad/Graphics, the nation’s second largest printer, installed its own on-site clinics two decades ago, mainly to keep its people well. It hired Mercer, a national benefits consultant, to see how they were doing on the cost side. Lo and behold, it was bringing in a full health plan at 20% to 30% below the U.S. average.

Its QuadMed subsidiary now provides medical homes in more than 40 on-site contracted clinics. Its customers include Briggs & Stratton, Kohler, MillerCoors, Northwestern Mutual Life, Greenheck Fan, Rockwell Stihl, Shaw Industries, Domtar and Safeway.

Why is there a rush to on-site and near-site medical homes across the country? It is because the present business model crafted by large health care corporations is largely a reactive system. They generally, though not always, do a fine job of fixing you when you’re sick, when you have a major medical issue.

But theirs is an expensive system that is based on specialty care. (Other countries emphasize primary care.) An office visit in the U.S. is often six to eight minutes, before being whisked off to a specialist. There is little time for a relationship.

In medical homes, it’s just the opposite. They are based on a relationship between the primary care providers and the employee/consumer/customer. Office visits are 30 to 45 minutes; they are holistic in nature.

That model has a big payoff, because it creates a proactive approach to heading off big medical issues. Doctor and patient collaborate to control chronic diseases like diabetes, hypertension and asthma – the known cause of 80% of the nation’s health care bill.

Done right, medical homes also deal with mental health issues like depression and behavioral problems, like smoking, binge drinking and drugs – all expensive propositions if left untreated.

Further, the on-site health teams act as gatekeepers to the expensive care at hospitals and specialist clinics. The employer’s doctor orders tests (only when needed), prescriptions (mostly generics), specialist care (only when called for), and hospital admissions (only when needed because they are expensive and sometimes dangerous places).

So, there are two big levers on costs in proactive primary care, a medical lever and a purchasing lever.

If medical homes can produce stunning savings through better workforce health in private companies, why wouldn’t the same model work in other payer arenas like Medicare, Medicaid and government employees?

Early returns suggest the proactive primary care model can work in the public sector. The West Bend School District in Wisconsin and the City of Kenosha both have created medical homes. Their contracted clinic vendor, Healthstat, Inc., runs more than 300 clinics, many for public employers.

Almost everyone would agree that their personal health is their most important asset. Employers would all say their people are their most important asset.

If that’s true, and we as a state want to walk that talk, wouldn’t it be a grand strategy to give every citizen proactive primary care in a holistic medical home?

It’s the difference between a long-term caring model and an in-and-out model.

Finally, some employers with on-site clinics have seen their hospital admissions drop by as much as half.

What’s not to like?

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