The right health care delivery system helps employers improve care, reduce costs

“[I]f employers have any hope of improving [health care] outcomes in the short-term, the employer must influence these patient–provider interactions by creating a better system of health and health care than we have today.”
The Road Ahead: Emerging Health Trends 2007, Hewitt Associates

Hewitt Associates recently conducted a survey to identify trends in employers’ health care decision-making. The recently released 2007 survey reveals, not surprisingly, that the overall business issues and the top workforce issues for employers are directly impacted by an employer’s health care coverage and delivery choices: business issues included managing cost, competitive positioning, and profitability; workforce issues included employee satisfaction, protecting employees against catastrophic health losses, and improving productivity.

All employers are fundamentally concerned with cost. The difference lies in their approach to managing them. Some choose not to deal with the issue by opting out of providing health care for their employees; others hope maintain their current level of involvement in employees’ health care because they view health care benefits as an attraction and retention tool; and then there are those who believe that managing their employees’ health is critical and view investments in health care programs as a long-term strategic business issue.

Recognizing the needs of employers, several Accountable Physician Practices are working with proactive employers to develop programs to help them address their business issues by coupling cost efficiencies with quality. Following are a few exemplary programs:

CAPP Physician Group: HARVARD VANGUARD
Project: CHRONIC ILLNESS CARE PROJECT
Summary: Physicians and other clinicians at Harvard Vanguard use medical information to integrate population management and chronic care programs into primary care with positive results in improved diabetes quality measures. Early management of such chronic illnesses will result in better lives for their patients and cost savings for employers.

For more information about this project or for an interview with Dr. Joe Kimura, please contact Marci Sindell at (617) 559-8323.

CAPP Physician Group: KAISER PERMANENTE
Project: HEALTHY HEART PROGRAM
Summary: Heart disease rates at Kaiser Permanente Northern California (KPNC) have dropped so dramatically that it is no longer the leading cause of death among the group’s patients, thanks to Kaiser Permanente’s Healthy Heart program. KP has now made the program available to all California physicians. If adopted, the state and its employers could save millions in health care costs.

For more information about this project, please contact Nancy Taylor, The Permanente Federation, at (510) 271-6995.

CAPP Physician Group: HENRY FORD MEDICAL GROUP
Project: Auto Manufacturer Care Innovation Collaborative: DIABETES IN ACTIVE CONTROL PROGRAM
Summary: Faced with rapidly escalating health care costs, leaders at the Big Three auto companies asked Henry Ford Health System and Health Alliance Plan (HAP) to identify ways to decrease costs while maintaining or improving care quality. Leadership at Henry Ford and HAP determined that by tapping into Henry Ford Medical Group and taking advantage of its electronic medical record to carefully monitor patients at more than 25 ambulatory and inpatient sites, both objectives could be achieved. Focusing on the treatment of chronic conditions, several initiatives emerged from the Auto Manufacturer Care Innovation Collaborative including the Diabetes in Active Control program. Seeking to manage the health of its employee population with diabetes, DaimlerChrysler launched the program targeting its World Headquarters employees first. The successful results motivated the automaker to expand the program into one of its assembly plants in early 2007.

For more information about this project please contact Dr. Bruce Muma, Henry Ford Medical Group at (586) 247-2670.

CAPP Physician Group: HENRY FORD MEDICAL GROUP
Project: Auto Manufacturer Care Innovation Collaborative: E-PRESCRIBING
Summary: Another initiative that emerged from the Auto Manufacturer Care Innovation Collaborative between Henry Ford Health System and the Big Three is the process of tracking and monitoring prescriptions to ensure that drug prescribing was safe and correct, as well as to increase the use of generic drugs. The program resulted in $14 million in annual savings by reducing adverse drug interaction and administrative costs, and increasing the use of generics.

For more information about this project, contact Dr. Bruce Muma (Henry Ford Medical Group), (586) 247-2670; Matt Walsh, Health Alliance Plan, (313) 664-8103.

CAPP Physician Group: KAISER PERMANENTE
Project: AVIVIA HEALTH POPULATION MANAGEMENT PROGRAM:
Summary: Kaiser Permanente’s Avivia Health’s population management program leverages extensive historical population data to tailor outreach programs for employees with chronic illness to help them play a more proactive role in their own health care through coaching and health education. Initial trial in Georgia saved $7.5 million.

For more information about this project, please contact Nancy Taylor, The Permanente Federation, at (510) 271-6995.

CAPP Physician Group: HENRY FORD MEDICAL GROUP
Project: Auto Manufacturer Care Innovation Collaborative: HEART FAILURE PROGRAM
Summary: Leveraging its extensive medical record, Henry Ford was able to target heart-failure patients with a health-coaching intervention. The program was developed to slow disease progression, improve functional status, improve quality of life, and reduce hospitalizations and ER visits among this patient population. The model not only resulted in significant clinical improvements, but a cost savings of $5,000 per member per year.

For more information about this project please contact Dr. Bruce Muma, Henry Ford Medical Group at (586) 247-2670.

CAPP Physician Group: HEALTHPARTNERS
Project: WORKSITE CLINICS
Summary: HealthPartners has partnered with five employer groups to open clinics at Minnesota worksites after a successful workplace clinic opening at Grede Foundries.

For more information about this project or an interview with Marcus Thygeson, M.D. of HealthPartners, please contact Joe Dangor at (952) 883-5223.

CAPP Physician Group: AUSTIN REGIONAL MEDICAL CLINICS
Project: EMPLOYEE HEALTH SERVICE CENTER PROJECT
Summary: The first year of Austin Regional Medical Clinic’s on-site Employee Health Service Center pilot with the Texas Commission for Environmental Quality shows success for all—patients, employer, and medical group—through fast diagnosis and prompt treatment, which leads to reduction in absenteeism and presenteeism.

For more information about this project or an interview with Norman Chenven, M.D. of Austin Regional Clinic, please contact Heidi Shalev at (512) 421-4811.

CAPP Physician Group: MAYO CLINIC
Project: COVERING 100% OF TRANSPLANTS FOR TYSON FOOD EMPLOYEES
Summary: Tyson Foods established a transplant benefit design that covers their employees 100% for transplants conducted at Mayo. Mayo transplants far fewer patients than are actually referred for transplant because of the health system’s effective conservative medical approach. The cost reduction that allows for 100% coverage results from contract discounts and the kind of comprehensive, coordinated care that patients can get at Mayo.

For more information about this project, or to interview Lee Kidd of Tyson Foods, contact David Bolling, Mayo Clinic Jacksonville, at 904-953-2286.

CAPP Physician Group: MAYO CLINIC
Project: CITY OF SAVANNAH EMPLOYEES' IN-NETWORK DELIVERY SYSTEM
Summary: The City of Savannah, Georgia, uses Mayo as its in-network care system for their employees who either need care they cannot get locally, or to assist local physicians in managing high-cost and complex cases, such as cancer, and to provide surgical procedures (such as transplants) when Savannah cannot otherwise accommodate them in-network.  The cost reduction results from contract discounts and the kind of comprehensive, coordinated care that patients can get at Mayo.

For more information about this project, or to interview Sandy Jones, City of Savannah, contact David Bolling, Mayo Clinic Jacksonville, at 904-953-2286.

CAPP Physician Group: HENRY FORD MEDICAL GROUP
Project: Auto Manufacturer Care Innovation Collaborative: CHRONIC BACK PAIN PROGRAM
Summary: Utilizing complementary and alternative medicine techniques, such as acupuncture and chiropractic treatment, and group classes at the workplace, Henry Ford helps reduce chronic back pain for GM employees.

Henry Ford Medical Group created an innovative workplace-based program to address chronic back pain among the employees at the General Motors headquarters in Detroit. The program was particularly innovative in two respects: Utilizing complementary and alternative medicine (CAM) techniques; and group classes versus the more traditional “one-on-one” treatment model.

In the study, CAM interventions were found to be between three and five times more effective than physical therapy in resolving back pain. The CAM protocols that were tested included chiropractic, needling acupuncture, electrical stimulation of acupuncture points, St. John Neuromuscular Therapy, movement re-education, and mind-body therapy.

Specifically, the percentage of individuals reporting zero average pain in the last treatment week was 55 percent (35/63) for the group class approach versus 5 percent conventional physical therapy (2/37). Results for the group class approach also significantly exceeded those resulting from one-to-one CAM interventions with individual patients. Generally, all CAM approaches were more effective than physical therapy.

For more information about this project, contact Dr. Robert Levine, PhD, Henry Ford Medical Group, (248) 342-7555; Matt Walsh, Health Alliance Plan, (313) 664-8103; Bruce Bradley, General Motors, (313) 665-1817.

CAPP Physician Group: EVERETT CLINIC, VIRGINIA MASON MEDICAL GROUP
Project: Boeing Company Intensive Outpatient Care Program
Summary: An innovative pilot program sponsored by Boeing, called the Intensive Outpatient Care Program, brings together the medical groups, insurer, and employer purchaser to identify and manage the health care quality and cost of Boeing patients with complex chronic conditions.

For more information about this project, contact Al Fisk, MD (Everett Clinic); Tim Neale (Boeing) at (312)-544-2921; Pranav P. Kothari, MD (Renaissance Health) at (301)848-8412; or Angela Hult (Regence) at (503)412.7902.

“CAPP’s 35 MSMGs [multispecialty medical groups] share a common vision as learning organizations dedicated to the improvement of clinical care. Their features include physician leadership and governance; commitment to evidence-based care management processes; well-developed quality improvement systems; team-based care; the use of advance clinical information technology; and the collection, analysis, and distribution of clinical performance information. These features are congruent with the [Institute of Medicine’s] recommendations on key elements needed to redesign delivery systems.”

From Chapter 5, “Developing the Test Bed—Linking Integrated Service Delivery Systems: Council of Accountable Physician Practices,” by Michael A. Mustile, MD. The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine), edited by LeighAnne Olsen, Dara Aisner, and J. Michael McGinnis, National Academies Press, 2007.

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“A shift from the current care model to a more coordinated care model centered on primary care is one potential way to help stave off the healthcare dilemma.”

“It's too expensive to be a primary-care doctor,” by Debra A. Geihsler, president and CEO of Harvard Vanguard Medical Associates & Atrius Health. Boston Globe, July 25, 2007.

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Medicare Payment Advisory Committee’s March 2007 Report to the Congress: “In three of the four [metropolitan statistical] areas, beneficiaries whose main physician was in multispecialty or hospital-affiliated groups had lower average annual spending than beneficiaries whose main physician was in solo or single-specialty groups. At the highest quintile of spending, all four areas show lower average spending for beneficiaries whose main physicians were in multispecialty or hospital-affiliated groups.”

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