Health, Not Health Care is the Goal

Suzanne B. Robotti
Suzanne B. Robotti Executive Director

What if your doctor got paid to keep you well and give you a health care?

Some hospitals and clinics have a deal with insurance companies to do that. Here’s the best part, the way they do it is to give above and beyond service to their patients. In a snowstorm, office personnel might call a list of cardiac patients and encourage them NOT to shovel snow. In a heat wave they might call elderly and make sure they have air conditioning and drink water. Diabetes patients could get calls at home to ask how their diet, exercise and medicines are going. Patients with a new prescription should be called to find out if the new medicine is effective and if the side effects are tolerable.

For the past several years a few hospitals and clinics have been experimenting with this concept without getting paid for it. Happily, “ObamaCare” encourages financial incentives for these programs. An example of one deal between Advocate Health Care in Oak Park, IL and Blue Cross Blue Shield was structured like this: the insurance company projected what the health care costs would be and set agreed upon measures of quality of care. If Advocate Health Care could keep costs below the projection and keep its patients healthy, they would split the savings with the insurance company. (Reported in the New York Times, 4/24/2013) The hospital succeeded, lowering costs by 2%. The hospital makes a bonus, the insurance company makes more money, and (I’d like to think this is the best part) patients enjoy better health and lower insurance premiums.

This standard of care can be applied to geographic areas that, for many reasons, send a lot of people to the hospital regularly. It’s called “Hot Spotting,” borrowed from police methods. Dr. Jeffrey Brenner was profiled in The New Yorker in 2011 (an awesome article – read it on our blog) and is a pioneer in hot spotting. By mapping ER patients’ home addresses, he discovered that 57 people who were in the ER from falls were all from one building in Camden, NJ – making it the number one place for falls in the area and costing more than $3,000,000 for that one building. Why do they fall? The building was filled with elderly. A doctor can’t fix aging, but can offer education, balance classes and other measures that dramatically lower ER visits.

Massachusetts General, in Boston, developed its own similar program targeting chronically high-cost patients. Each patient was assigned a personal nurse to coordinate care for that individual. In addition to regular doctor visits, the nurse spent extended time with the patient and called the patient at home. The nurse knew if a prescription wasn’t filled and if the prescription was ineffective or had intolerable side effects – all before an illness became urgent. The result? A 5% drop on cost of health care for these most-expensive patients.

If old-fashioned, personal care can lower costs, how can we not afford to offer this better care to everyone?

Should health be the goal instead of health care? What do you think? Please write and tell me on Facebook.

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