By Bonvissuto, Kimberly
Medical Economics , Vol. 89, No. 24
How primary care can reshape healthcare economics through preventive medicine
Billions of dollars could be shaved from the nation's annual $2.5 trillion healthcare bill with a greater focus on disease prevention, in forms such as tobacco cessation; alcohol abuse screening reduction of weight, blood pressure, and cholesterol risk factors; and the encouraging of daily aspirin use.
As part of its 2011 National Prevention Strategy report, the National Prevention Council found that
* a 1% reduction in weight, blood pressure, glucose, and cholesterol risk factors would save $83 to $103 annually in medical costs per person;
* annual healthcare costs are $2,000 greater for smokers, $1,400 for people who are obese, and $6,600 higher for individuals with diabetes than are costs for individuals without those conditions; and
* medical costs are reduced by about $3.27 for every dollar spent on workplace wellness programs.
Those statistics, combined with continuing increases in healthcare costs, have sparked greater interest among the nation's employers in wellness services for their workers. In response, some primary care practices are expanding beyond their office walls to bring services directly to the workplace.
Although original workplace clinics provided more occupational health or urgent care services, the trend is moving toward wellness and primary care services. The option provides convenience for the employee and delivers a happier, healthier, and more productive workforce for the employer.
A MODEL PROGRAM
Dartmouth Health Connect is turning the practice of primary care on its head through its new delivery model that promotes wellness. The primary care practice opened in February in conjunction with Dartmouth College in Hanover, New Hampshire, Dartmouth-Hitchcock health system in Northern New England, and lora Health, a Cambridge, Massachusetts, healthcare company founded by Rushika Fernandopulle, MD, MPP, who serves as chief executive officer.
The practice- which is not a walk-in clinic- includes two Dartmouth-Hitchcock Medical Center physicians, a nurse, a practice coordinator, and several health coaches. The primary care practice offers physicals, vaccines, sick visits, prescriptions, and ongoing care to Dartmouth College employees.
Instead of the usual fee-for-service model, Dartmouth pays lora Health a monthly per-patient fee, providing an incentive to focus on patient health, Fernandopulle says. Enrollment is voluntary, but more than 650 patients have signed on to the new program.
lora Health, the successor to Fernandopulle's Renaissance Health, already runs similar practices in several other locations, including in Nevada and New Jersey, where the focus is on casino union workers, and in Seattle, which caters to Boeing employees. He plans to open additional practices in 2013 in Brooklyn, New York, and Boston, Massachusetts. Fernandopulle says the model produces an average net healthcare spending reduction of 20%.
'Our model is, employees don't pay anything out of pocket. It's completely free to them," Fernandopulle says. "We get paid per employee, but unlike concierge care, the employer is paying that They are the ones who will benefit when dollars are saved.
"We are outside the insurance system. We do an end-run around the insurance company. We directly contract with the employer."
PUTTING IT ALL TOGETHER
Fernandopulle says that to change the model of primary care, it is imperative to start from scratch, lora Health designed the practice space to meet the needs of Dartmouth Health Connect, hired a new team, trained health coaches, and even designed its own information technology system, which alerts the practice when patients are having health problems and allows patients to view and enter information in their own medical records.
"People feel it's a better service," he says. When first starting out, Fernandopulle says, he tried what other practices sometimes do: running a standard primary care practice while adding corporate wellness programs at different locations. …