Reformers race to proactive primary health care

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 make the case for a disruptive new business model to shake the foundations of their industry.

Though Joe Piemont, Dr. Suzanne Gehl and Rhonda Lockhart are in very different places in the care landscape, they were aligned recently in presenations, maintaining that the present model for the delivery of care is busted.

Their viewpoints are shared by many reformers in what amounts to a grassroots revolution to fix the structure and economics of U.S. health care.

They were not talking about the Affordable Care Act, which deals primarily wih insurance reform.

Joe 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.

“Why do we have this continuing and spiraling trend upward on health costs?” he asked.

His answer: “Health care has been mainly about rescue, and rescue is expensive.”

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.

That means keeping people out of hospitals, not filling beds for revenue sake. So Piemont could be viewed as a reformer from inside the huge health care industry. The nation needs such transformation from the inside.

Nonetheless, business people know that the biggest lever for pushing higher levels of performance comes from customers – from the outside. When a customer says jump, the vendor response should be “how high?”

Rhonda Lockhart and Dr. Suzanne Gehl are two such reformers. They are among the innovators in the private sector whom are causing transformation from the outside.

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 clinic in 2004 with a nurse practitioner and added a part-time doctor to its contracted staff last year. Adding the doctor “really made a difference,” she 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 come to 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 then 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.

Look to QuadGraphics, the nation’s second largest printer, for longitudinal proof of the effectiveness of the new model. Quad has been using an on-site clinic since 1990 and brings in care at 30% below the U.S. average. Its subsidiary QuadMed now runs more than 100 clinics for large employers across the country.

The improvements in workforce health and containment of health costs, which together should be a top corporate priority, explain why private payers, entrepreneurs and a few smart systems are stampeding to what’s known as medical homes on-site or near-site.

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