If You Want Better Health Care: Own It!

No One Cares for the Health Care of Your Employees Like You Do.

Light a Candle! Don’t Curse the Darkness

When I learned about the best health care in America, it surprised me. The Southcentral Foundation in Alaska has quality scores in the 75^th to the 90th percentile, it has won two Malcom Baldridge awards, it provides care at half the cost of other healthcare systems in Alaska, and it serves Native Alaskans. This is a very challenging situation. Their populations are isolated and scattered over thousands of square miles that are not connected by roads. Ordinarily, Native Alaskans are disadvantaged and carry a higher burden of chronic illness. They are twice as likely to have diabetes, struggle with obesity, and they are more likely to be smokers. This burden of chronic diseases makes the care for Native Americans more expensive in most places, but this system provides better care at lower cost. How is that possible?

The answer is shockingly simple. Native Alaskans own the system and run it. The people who need the care design the care. Those who use the system are always referred to as customer owners. Those who receive the care decide what the priorities are and how to meet them. Their solutions do serve them very well and are tailored to their needs. It is based on advanced primary care and 85% of the care is delivered by telehealth rather than in person visits. This great podcast provides more detail from their chief medical officer. (The first two minutes are in Swedish. Just hang in there).

This concept is not theory for me. I have been actively involved in an effort like this for four years. The Vestra work site clinic that serves the Coushatta tribe in the continental US. The tribe determines the priorities and what they will pay for. I have taught the clinical staff about optimal medical therapy (OMT) and provided the protocols for that work. I have been working with Congruity Health for over two years and we have been doing their analytics for a year now. Patients who receive over half of their care with the clinic team cost roughly half as much as those who receive usual care in the community including clinic costs. These savings are based on dramatic reductions in hospitalization, length of stay, ER visits, urgent care visits, and specialty referrals. There are fewer encounters for these services and the price is directly negotiated.

The Germans use this approach much more broadly. As in this country, most Germans receive their health insurance through their employer, but that is where the similarity ends. In this country, that insurance is managed by businessmen and women who answer to stockholders and do pretty well for themselves. The entire German system is like the Southcentral foundation. Elected representatives of the insured and of the employers govern the employer’s health plan. They decide what the priorities are and how to meet them. They control the money and the data that shows how the money is spent. They have the information that they need to understand the health benefits and the spending that achieved those benefits. The elected representatives arrange negotiations for hospital rates and drug prices. Like the Native Alaskans, they control the system, and like the Native Alaskans, they live longer for much less money. That increased spending here does not produce the quality of care we should expect. On most quality measures, America ranks last among the developed countries.

The insurance most Americans depend on does not serve them well because they have nothing to say about it. Check out this brilliant article on the topic from Wendell Potter, a former Cigna executive. “I explained how share repurchases benefit top executives and other shareholders at the expense of the insurers’ customers–especially health plan enrollees with such high out-of-pocket requirements they’re getting buried under a mountain of medical debt. As Forbes reported last July, those out-of-pocket requirements have reached such heights that millions of Americans are now “functionally uninsured.” The leaders of these systems receive a total compensation package of as much as $180 million dollars a year. They don’t serve you. They serve themselves and other stockholders. You will never have better health at lower cost as long as these people are running the show. This system is the darkness.

Don’t curse the darkness! Don’t be consumed with anger and resentment! Light a candle! Do something! You can have this system right now in the United States. I am working with a group of healthcare stakeholders who can help your county or municipal government, your school district, or your employer run your own health plan with elected representatives from the employer and the employed. We have all the systems required to support you.