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Big companies looking for big changes in health care Print E-mail
Thursday, 06 May 2010

By Jeremy Smerd

It's no surprise that blue chip companies are also deeply involved in managing their company's health care benefits. The reason is obvious: health care is one of the biggest costs of any company and often employers are left to wonder what they are getting for their money.

That's why IBM-perhaps the very definition of a blue chip-is deeply involved in trying to change the way health care is provided. One of the company's most sought after goals is to improve the primary care system in the United States. Their feeling is that doing so will ultimately improve the health of their workers and their worker's productivity. (The changes the company is seeking may also improve its health care technology business if more primary care docs use electronic health records.)

An article this month in the journal Health Affairs, written by Paul Grundy, IBM's global director of healthcare transformation, makes the case that more employers need to get involved in changing primary care. The article (which is behind this paywall) begins with a quote from other researchers that neatly sums up his argument:

"Employees and their families who lack effective primary care, prevention, and chronic disease management often cannot be productive members of the workforce."

The "productivity" argument of course has been used to justify anything from treadmill desks to video games in the workplace.

Grundy though is making the case not for short-term improvements in the costs that drive up a company's health care bill-unneeded trips to the emergency room, for instance. He's really focusing on, as his title suggests, total transformation of the way businesses interact with the health care system.

The model he says more employers are demanding is one that puts primary care at the center of a patient's health care experience. It's called the patient-centered medical home, one of the most popular new approaches to health care. Pilot programs all over the country are poised to receive federal money thanks to the stimulus bill and health care reform.

Put simply, the medical home puts the patient at the center of a team approach to health care that connects a patient's various doctors. Led by a primary care doctors, this team of doctors and nurse practitioners actively manage a person's health, especially those with chronic illnesses. Crucially, it is designed to pay primary care doctors more to spend time helping, coaching, prodding and following-up to make sure patients take their medicine and stay healthy. It also pays for email and phone consultations, making access to a doctor easy, quick and, for the doctor, worth their time.

According to Grundy's article, a senior VP for HR at IBM, J. Randall MacDonald, was asked by a congressional committee what he thought was the most important repair the health care system needed. He said fixing primary care was the foundation for fixing everything else wrong with health care, namely an epidemic of obesity, a system that cares for people when they are sick but doesn't help them get healthy and a system that rewards tests and technology and surgery-quick fixes-but doesn't pay doctors to spend time with patients.

"Primary care is foundational, but we need it to be smarter, with the tools and payment reform to allow it to be better integrated, continuous, coordinated, and comprehensive," he said.

IBM, like so many companies, has a lot riding on their support of primary care. The company covered more than 450,000 employees, dependents, and retirees in the United States, at a cost of $1.3 billion in 2008.

IBM, with other employers, helped found the patient-centered primary care collaborative. To learn more click here.

It's not necessary to read Grundy's article but it is important for employers around the country to understand that patient centered medical homes are an influential and important trend. Some companies, like Boeing, have sponsored pilot projects and have seen some employees improve their health and become more productive, helping the company save money.

Taking a much overused phrase, health care is too big to fail. Grundy argues that primary care is too important to fail. He is calling on employers to join with health care providers and insurers and government agencies to support medical homes around the country.

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