Our current healthcare system is designed around large hospital systems that rescue patients very late in the chronic disease process. That does not meet the needs of your town today and it is not in keeping with the latest medical science and systems. That system dates to the days of the rotary telephone.
Fifty years ago, we did not understand how chronic diseases work nearly as well as we do today, and Americans did not live as long. Today, with a sedentary, overweight, aging population, chronic diseases are the most important healthcare challenge in our country. These problems also cause most disability and death. Eighty-six percent of all healthcare spending comes from patients with chronic conditions. The more chronic illnesses a patient has, the more expensive they are to care for, but our current system is not set up to deal with that reality at all. That is your opportunity to lead the way.
Today’s new medical science enables us to identify patients with vascular disease, high blood pressure, and diabetes very early. If you have extra abdominal fat, high blood pressure, high cholesterol, diabetes, or smoke cigarettes, you already have arterial disease and an increased risk of heart attack or stroke. If you have already had a heart attack, or have other artery disease, or chronic kidney disease your risk is much higher. An independent advanced primary care office that is focused on these chronic diseases that cause most disability, death, and cost can make all the difference. If a person who has had a heart attack gets best practice medical treatment for their known arterial disease, they are ten times as likely to be alive in 5 years as patients who get their care in the current system. Their care costs tens of thousands of dollars less per patient annually. It is the same for patients with type 2 diabetes and chronic kidney disease. If these patients get best practice medical treatment, they are one fourth as likely to have a heart attack, one fifth as likely to have a stroke, and one sixth as likely to go on dialysis. Health care clinicians call this best practice care optimal medical therapy (OMT). The new scientific treatment of chronic disease is extremely effective.
OMT is so effective that it dramatically reduces hospitalizations, expensive tests, and referrals to specialists because it keeps you healthier. That is bad news for big health systems but wonderful news for everyone else. OMT for heart disease and related diseases like diabetes and high blood pressure keeps people healthier. That means that they are in the hospital one fifth as often and in the ER one third as often. Isn’t that what you want from your healthcare? I hate being in the hospital.
We are so focused on hospitals in healthcare that even small rural counties think they need one. I know of one small town of about 5,000 people that is ten miles from a teaching hospital. They struggle to keep the hospital in their town going. It really makes no sense. They could reach that larger more effective hospital in ten minutes. They could use their limited resources to develop an advanced primary care practice focused on chronic diseases. That way their citizens would need a hospital less often because their health is better. They could be healthcare leaders without all the expense involved in running a hospital.
How would you bring independent advanced primary care to your town? It is easy. You can begin with an elected health commission that functions like the water commission I wrote about in my last post. You set the priorities for your water system, and you can set the priorities for the health services you sponsor as well. You may already have a primary care practice in your town that is independent and willing to do something innovative. If you don’t have that, in half the states in the country, nurse practitioners can practice independently. You can begin with a single nurse practitioner and rent a small office for her to work out of.
You can have world class care very inexpensively. Eighty-five percent of managing heart disease and diabetes can be done remotely with visits over the phone or the computer. Imagine what that means for your town. You don’t need large, fancy, expensive buildings ever. Your clinicians and teams can do a lot of this work from home. Doing the work remotely means you can cover a much larger geographical area and you can save your people lots of time and travel expenses. You can make care much more convenient. Your county and school employees can get care without taking the day off. Nurse coaches can establish long-standing trusting relationships with the people who live in your town. The most modern information technology systems and other supports can make your coaches more effective and more efficient.
That nurse practitioner will need support too. Optimal medical therapy is a product. Producing any product consistently requires systems, standardization, and protocols. Clinical analytics determine where your team is doing great and where there is an opportunity to improve. Financial analytics show how the team improving the clinical and financial results for the people in your town who use the clinic vs those who get their care somewhere else? This clinic can lower healthcare costs for your county or municipal employees, including those in your school system.
I work with other stakeholders at Health Direct Partners who can support you in your efforts remotely and very inexpensively to consistently produce OMT. They can bring self-insured rates to employers in your community with as few as five employees. That is a huge community benefit. They work with smaller insurance companies that understand this new model and give you access to all your data so that you can see how hospitalizations and ER visits are falling along with health care costs for your county employees. They arrange stop loss insurance coverage for very high-cost cases. They provide all the services that you get from your current large insurance company, but they do it more effectively and for less money. They do it transparently without all the good ole boy deals. They negotiate direct contracts with regional hospitals, ERs, surgery and imaging centers to get you the best rates. They also provide the information infrastructure, nurse coaching services, financial analytics, clinical analytics, and the protocols and systems needed to produce OMT. Many medical organizations believe that they are doing this work, but they are not saving you money and they are not reducing the number of your neighbors having heart attacks, strokes, and going on dialysis. The data is critical to prove what is happening.
There is a new federal law called the Consolidated Appropriations Act. Under the provisions of that act, self-insured employers—including county and municipal governments— have a fiduciary duty to show that the care their employees receive is effective and fairly priced. Most care in the current system is neither. This is the same level of fiduciary duty that you have for your employee 401k plan. It is serious business. Our stakeholder collaboration provides you with a dashboard that gives you the information that proves you are meeting your fiduciary duty at all times. It shows where your healthcare dollar is going and how effective your healthcare system is in keeping people out of the hospital. Obtaining these benefits is simple. There is only one contract. We know every community is different and one size does not fit all. We can adjust what we are doing to meet your unique needs and preferences.
If you are a community large enough to have a city or county water system, you are large enough to have an advanced primary care team producing optimal medical therapy. The approach we are advocating is rarely available in this country. Most patients and employers don’t have access to it. Your community can help lead the way to a much better healthcare system that meets your needs better. It will help you live a longer healthier life.
Summary Points
The best health care systems in the world and in America are based on advanced primary care and they are owned and run by the people they serve whether it is a country, county, municipality, or self-insured employer. It is only by owning and running your health services that you can set the priorities for healthcare in your community. One of the priorities should be keeping your citizens healthy by delaying the onset of chronic diseases and treating them more effectively. That way they don’t need hospitalization or emergency room visits nearly as often. Your smaller community can lead the way to this new system.
The best examples of community owned healthcare in the United States are the Southcentral Foundation in Alaska and Vestra Health. Go to this series of brief podcasts from the Southcentral Foundation and begin with the one from June 16, 2023 at the bottom of the page. It is only 9 minutes long and it is critical for you community leaders to understand how this works. The Alaska group and Vestra Health provide world-class healthcare in rural areas at half the cost of care in the broader community. Both have very high quality scores. Better care is less expensive care. Patients seen at Vestra Health are in the hospital one fifth as often and in the ER one third as often because they are healthier.
In our current healthcare system, the priorities are set by large health systems and insurance companies owned by stockholders. These priorities are not your priorities. Those priorities are set by people who don’t live in your community and don’t understand what you need. The current system will never give you better health at lower cost. Rescuing people late in the disease process is more expensive and less effective than keeping people healthy. No one is going to solve your healthcare problem for you. Only you can do that.
If your community is big enough to run its own water system, it is big enough to own and run its own advanced primary care team. That is the most powerful thing you can do for the health of your citizens.
Start by establishing an elected community health commission that is just like your elected water commission. Health Direct Partners can help support your commission in getting this practice started and supporting it in treating chronic illnesses more effectively. You can do this with a very small investment.
In states where nurse practitioners can practice independently you can begin with a small office and a single nurse practitioner. If you have a larger community in a state where nurse practitioners cannot practice independently, begin with a single primary care doctor (family practitioner or internist). That primary care doctor can support three or four nurse practitioners in their work. Be sure the people you hire are willing to focus on chronic illnesses and are willing to use protocols and systems to produce OMT more consistently.
As it stands now, smaller and medium sized communities are getting the short end of the healthcare stick. Their medical solutions are dominated by large health systems in much bigger towns and by large insurance companies who answer to stockholders. The large health systems view your medical facilities as a feeder system that keeps their beds full, their specialists busy, and their testing schedules full. Your needs and expectations of healthcare are different. You need healthcare that makes it less likely you will need hospitalization, specialist care, or an expensive test. Medical science and systems have advanced so much that these dreams are practical now. Let’s talk. I will be happy to answer your questions.
I can put you in touch with the people who can help you get started. This is one of the best things you can do to make your community better. My e-mail address is whbester@gmail.com.
Great to hear from you David. Attorney Chris Deacon and consultant Jeffrey Hogan write about this regularly and have great insights. Of course the big insurance companies want nothing to do with sharing data and transparency. There are already lawsuits in process. The lawsuits are by employers against third party administrators. Deacon and Hogan believe the CAA is the most powerful reform tool we have had. Here is a summary of suit types from Ms. Deacon.
1. Breach of Fiduciary Line of Cases Against Carriers
a. Bricklayers vs Anthem Class Action
b. Mass Laborers vs Blue Cross Blue Shield
c. Member vs Cigna
2. Carrier vs Hospital (upcoding) and Hospital vs Carrier (underpayment)
a. United vs TeamHealth
b. TeamHealth vs United
3. Taxing Authority vs Nonprofit Hospitals
a. Tower Health line of cases in Pennsylvania
b. Pittsburgh vs UPMC
https://relentlesshealthvalue.com/episode/ep408-whos-suing-who-an-overview-of-healthcare-legal-goings-on-with-chris-deacon
https://relentlesshealthvalue.com/episode/ep342
I do agree with you on the problem of small towns and gigantic medical centers. However a step is missing. For 7 decades I have been a law-abiding patriotic trusting person trying my best to stay healthy and do what is right. The past 4 years have shown us that nothing is as it seems. When the medical complex refused very effective early treatment for covid that could have shut covid down within a month or 2, I lost all faith in medicine. I now avoid doctors like the plague which I know is not really the wisest thing either to do either. My own GP of 20 years was trading covid in March 2020 with very effective off-label early treatment. Hydroxychloroquin. None of his patients even went to the hospital. But by June his huge medical practice sent down a ruling that they would lose their license if they continued to do early treatment. He complied. So I lost total faith even in my doctor of 20 years. And i'd almost rather die than go to a hospital. So the problem you address here assumes that the medical system is not corrupt and is there to help the common person. I no longer believe this. 4 years ago I realized I am completely on my own to try to keep myself as healthy as possible. This 15 minute talk sums up the way I feel. I wish everyone could hear it whether they agree with it or not, maybe it will make them do a little bit of critical thinking. "Here’s the Problem With Mainstream Heart, Diabetes, and Alzheimer’s Medicine: Dr. Paul Marik | Florida Summit https://link.theepochtimes.com/mkt_app/epochtv/heres-the-problem-with-mainstream-heart-diabetes-and-alzheimers-medicine-dr-paul-marik-florida-summit-5539142?utm_source=andshare. "