A Proven Path to Better Health at Lower Cost in the United States
More on How Vestra Is So Successful
The last post described the remarkable success of the Coushatta Casino Resort worksite clinic in Southwest Louisiana run by Vestra Health. The most important fact about their success is that it is easily scalable. They have also taught us what really works. They focus their efforts on chronic conditions which generate 86% of costs and most premature death and disability. There are all kinds of ideas about better chronic condition management that make plenty of sense. They make sense, but they don’t work. Most efforts to improve health, decrease cost, reduce ER visits, and lower hospitalizations fail. There are many examples that explain the failure. The biggest reason is they don’t focus on the patients with high-risk, high-cost conditions or the factors that lead to those conditions.
Here are some real examples. Patients with blocked arteries have chest pain with stress or exercise and they die of heart attacks. So opening arteries should prevent heart attacks and related deaths. Great idea! It just doesn’t work. Similarly, best practice medical treatment (optimal medical therapy) is the most effective treatment for established arterial disease. It does prevent heart attacks and related deaths, but there too there is disagreement. There too there are ideas that make all the sense in the world, but they simply don’t work. “Many approaches have been tried to improve diabetes care but, with one exception, have been mostly ineffective. These include simply reminding patients about appointments; providing laboratory information on the patient to the physician, even when specific treatment recommendations for the individual patient were included; case management when the case manager could not make independent treatment decisions; education of physicians; and multifaceted quality improvement interventions in the practice setting…The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms.”
That is exactly what Vestra does. Dr. Nick Heinen leads a team of nurse practitioners who are trained in optimal medical therapy and have full authority to make changes in treatment without checking with him. They use a very well-defined protocol and they are all on the same sheet of music. I spend a lot of time in this space, and this is the best team in the business.
There are other ideas about the best path. Some say it is all about patient engagement and the actual intervention is secondary. Dr. Heinen’s team understands the key role of engagement and trusting longitudinal relationships. They agree patients are the most important members of the healthcare team, because if they don’t understand their disease and trust the other team members, successful self-management of chronic disease cannot happen. That said, engagement and trust only produces these great results when best practices are employed. Success requires the best of the new science and systems combined with a new payment model. Individual factors are not the answer. Success requires a comprehensive solution. Vestra Health has achieved wonderful results by pulling every lever they can identify.
Chronic disease management requires time. The Vestra team spends enough time with patients to develop a trusting relationship and help them understand their disease and treatment.
Clinic visits are free.
Free visits increase patient engagement and facilitate steering the patient to higher quality specialists and facilities when needed.
The team consistently produces optimal medical therapy for cardiometabolic disease with training, systems, and protocols from Congruity Health.
The team does not just focus on diabetes or heart artery disease. They apply optimal medical therapy to hypertension, diabetes, high cholesterol, coronary artery disease, chronic kidney disease, and congestive heart failure with equal skill.
They have used prior authorizations to get patients into the clinic prior to expensive procedures to explore more effective alternatives.
They use ConferMED electronic consults for specialists like dermatology, cardiology, rheumatology….
They have Integrated Mechanical Care onsite to provide musculoskeletal diagnosis prior to orthopedic procedures. They teach self-management of back and joint problems.
Allergychoices provides implementation of allergy diagnosis and testing to address employees/dependents suffering from allergic disease and its related conditions of asthma, sinusitis, eczema and others. Vestra providers prescribe treatment using sublingual immunotherapy (drops under the tongue) to conveniently (safely taken at home) retrain the employees/dependents immune systems and gradually eliminate the allergy and related conditions.
There is a prior authorization stop for all specialty drugs and they reach out to affected patients to see if they are OK with the primary care clinical team helping in the management of those drugs along with seeing if we can source the drug cheaper.
They provide telepsychiatry and on-site counseling. That makes chronic condition management more effective.
They use direct contracting for inpatient services, ER, and urgent care.
They have real-time clinical and financial analytics with an employer dashboard.
They use a population health tool to identify members who have not been seen, have not had a visit, or have not had a test within an appropriate time frame.
That is what it takes to improve care and lower costs. We continue to have discussions with the Vestra leaders. We are learning how to do this work better together. As their company grows, administrative costs will be spread out and costs can decrease even more. Automated identification of high-risk, high-cost patients and providing lists of gaps in care to nurse coaches can help. A platform that increases patient-engagement, provides patient education, and sends reminders can make the program more efficient. They are learning more about the ideal staffing levels. I am confident they will continue to improve health and reduce costs.
Their worksite clinic model is an ideal way for self-insured employers to improve health and reduce costs for their employees. The clinic can implement the systems and protocols needed to produce great results, but it is not the only way to get there. An advanced primary care medical home team within a larger practice can also produce great results with an appropriate payment model. Telemedicine can work with the same supportive interventions. Patients can measure their blood pressure and sugar at home. Adjustments to treatment can be made over the phone. The key element is the systems and protocols to be certain that every patient receives the best care at the right time every time.
We also work with another stakeholder collaboration, Health Direct Partners, which is a carrier alternative. It brings together the same type of stakeholders as Vestra but at a much larger scale. Open the link to see detail. Health Direct Partners brings self-insured rates to very small employers while providing better health at lower cost.
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Did you ever read “slow medicine”?
This is so interesting. Things should change here. We are not delivering the health outcomes that we should be and what we are delivering is the most expensive useless care with hidden fees.