Editorial
Health Care Where You
Work
Published: September 2, 2012 - New York Times
In the scramble to find ways to slow rising health
care costs, experts are finding good ideas from organizations that are virtually
unknown beyond their hometowns.
Consider Bellin Health, a not-for-profit health care
system based in Green Bay, Wis. It has managed to rein in costs while improving
the availability and quality of care — in large part by making it easier for
patients to see nurses and primary care doctors. For employers, it builds
clinics right at the workplace so workers can have minor ailments treated before
they become serious, as well as many kinds of preventive care.
Although it is relatively modest in size, with a
178-bed community hospital and a primary care practice staffed by 95 doctors,
Bellin, in partnership with a neighboring health care system, has been chosen by
the federal government as one of 32 pioneering groups to test a new Medicare
payment system that rewards providers if they reduce spending but penalizes them
if costs soar. If successful, this program could be copied by private insurers.
Bellin ranks in the top 4 percent of hospitals in
holding down costs in the last two years of life, with its overall spending per
Medicare beneficiary 20 percent below the national average, according to data
compiled by the Dartmouth Atlas of Health Care. Bellin has also cut health costs
for its own employees. In 2002, its annual spending on health care had reached
$10 million and was projected to jump to $13 million in 2003. With a vigorous
effort to improve efficiency, between 2003 and 2011 it squeezed the growth of
its annual health care spending per employee to well below the national average.
Yet despite cost containment, Bellin ranks among the
best in quality of care. For the three years ending June 2011, Bellin was 16th
in the nation in preventing deaths from heart attacks, ninth in preventing
readmissions to the hospital within 30 days of a heart attack, and 23rd in
preventing readmissions for heart failure patients, according to comparative
data for thousands of hospitals compiled by the Centers for Medicare and
Medicaid Services. Bellin’s rates of catheter-related bloodstream infections and
ventilator-associated pneumonia are a fraction of the national rates.
EMPLOYERS WHO SEE RESULTS A number of
medium-size companies have contracted with Bellin to establish clinics at their
work sites, staffed part-time by nurses, nurse practitioners or physician
assistants, who handle minor injuries and illnesses, promote healthy living and
conduct preventive screenings. On a recent visit to Bellin Health and several of
these clinics, we found employers who said Bellin was slowing or even reducing
their spending on health care. The Fincantieri Marine Group, which builds ships
for the Navy at its facility in Marinette, Wis., was spending $17 million on
health care before Bellin set up a clinic in a trailer at the plant in early
2011. By year’s end, its total spending was down to $15 million even though the
work force had grown a bit.
Northeast Wisconsin Technical College estimates that
Bellin has slowed the growth rate in its health care spending so much that it is
saving about $500,000 a year. The Foth Companies, an engineering and consulting
firm, which spends about $5.5 million a year on health care, estimates that
Bellin has saved it about $250,000 a year through its on-site clinic and other
tactics, like better disease management. La Force Inc., a maker and distributor
of metal frames, doors and hardware, says that with Bellin’s help, its spending
on health care has been growing by less than 2 percent a year on average over
the last four years.
HOW DID BELLIN DO IT?
Bellin’s approach puts a lot of emphasis on getting medical attention
promptly. Patients are generally guaranteed access to whatever level of care
they need on the day that they call. Nurse practitioners treat minor illnesses
like sinus infections, prescribe medications and perform lab tests on blood and
urine. Bellin pays its doctors on a fee-for-service basis, which can provide
financial incentives to increase the number of tests and procedures performed.
But Bellin counters that problem by investing heavily in primary care and
adopting clinical guidelines that deter unnecessary treatments.
Bellin’s own employees are encouraged to use FastCare clinics that Bellin has
established in local ShopKo retail stores. Bellin pays the entire $56 cost of a
clinic visit and charges its workers nothing, which gives them an incentive to
avoid making expensive emergency room visits. Bellin calculates that doing this
has saved more than $52 million over four years.
WORKPLACE CARE CATCHES ON A survey
last year by Towers Watson and the National Business Group on Health found that
23 percent of midsize and large employers offered on-site health services and 12
percent more planned to in 2012. Health experts have published research in
journals like the Harvard Business Review and Health Affairs showing that every
dollar invested in employee wellness programs saves multiple dollars by lowering
a company’s health care costs, reducing absenteeism and increasing productivity.
Wider use of workplace clinics, by improving access to care, could yield
substantial nationwide savings.
•
This is part of a continuing examination of ways
to cut the costs of medical care while improving quality.