Was encouraged to read in Overkill, Atul Gawande's current New Yorker article, about an employee health care benefit that Walmart (yes, Walmart!) has introduced. Employees who have been recommended for spine, heart, or transplant procedures get care with NO out-of-pocket costs IF they have the procedure at one of six “centers of excellence”: the Cleveland Clinic; the Mayo Clinic; Virginia Mason Medical Center; Scott and White Memorial Hospital; Geisinger Medical Center; and Mercy Hospital Springfield. All top flight medical institutions, scattered around the country. Not only is care covered, so are all related expenses - including hotel & food - for the patient & a support person. Employees who've taken advantage of the program report they felt like royalty!
Now, everyone knows that Walmart - famous for its cost-cutting ways - isn't offering this program simply out of the goodness of its corporate heart. While they hope their employees get better surgical care, top brass are also aware that spine, heart & transplant procedures are mega $$$, with costs typically running from tens of thousands to hundreds of thousands of dollars. Complications can drive up the cost even higher. If a procedure fails, if an employee is left permanently unable to return to work, then the costs go higher yet. By contracting with six truly exception medical centers, Walmart employees realize lower than averaage complication rates. Because the centers contract a fixed, package price with Walmart, the corporate giant can provide exceptional care to its employees while it enjoys exceptional savings.
The biggest surprise to come out of the program is that sources of the biggest savings - effectively avoiding unnecessary tests, procedures & treatments. Sally Welborn (the name is too perfect!), Walmart's senior v-p for benefits, estimates that about 30% of the once recommended procedures turn out to be unnecessary - more effective care can be provided without surgery or there was more risk than benefit. A former head of neurosurgery at one of the "centers of excellence" confirmed that patients sent to his medical center occasionally didn't meet its criteria for care.
Virginia Mason Medical Center, confirmed that large numbers of the patients sent there for spine surgery do not meet its criteria.
Atul does see improvement since 2009 & the passage of the Affordable Care Act (ACA) in 2010. He discovered that the cost of our nation's health care inflation rate is at its lowest in more than fifty (50) years, that costs per Medicare patient have flattened across the country. It's not just because of what's built into the ACA, but because doctors & medical professionals realize they are being watched. Carefully. People may scream that the government is coming between a doctor & his patient, but the reality is that it's often necessary. It's easy for a doctor to write out a prescription for a test or an exploratory procedure, but he's not the one undergoing or paying for it!
To my surprise, one of the benefits coming out of the ACA is the rise of "slow medicine," a term I'd only just first heard the day before our New Yorker arrived. Talk about timing! Part of slow medicine is taking more time with patients, asking more questions, getting more background, NONE of which was encouraged when I worked at USHC & PHC twenty, thirty years ago. Now, the ACA creates oppportunities for medical professionals to take their time. Any group of docs with 5000+ Medicare patients can be considered an "accountable-care organization" & contract directly with the government, potentially saving up to 60% of any saving they produce.
As Atul points out, no one system is a cure-all for our nation's health care delivery problems. Each time a new system is designed to solve a problem, it ends up creating new ones. There is no perfect, but there can be better.
If those aren't encouraging words (and from Walmart!), I don't know what could be!
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