The ‘nurse fix’ for American healthcare
I’ve said it before and will, no doubt, say it again – lowering health care costs in America will not happen by grand, national legislation. It will happen locally and it will happen when the stakeholders in the healthcare system begin to creatively focus on the problem in a meaningful way.
We now have a case in point that proves the point.
Geisinger Health System operates clinics, hospitals and primary practice physician’s offices in northeast and central Pennsylvania. They also offer a health insurance plan that covers about 250,000 people, most of whom get their health care from Geisinger’s network of care providers.
Following the logic that expensive hospital care can be avoided if patients – particularly those with chronic illnesses – are treated more effectively in the doctor’s office, Geisinger’s insurance company began experimenting with the medical home concept whereby more attention is paid to patients at the time when something can still be done to control these illnesses.
The idea is simple. Using diabetics as an example, we know that when diabetes is not effectively treated it will often lead to heart attacks and other serious complications requiring expensive hospitalization – an experience potentially lethal to the patient and dramatically more expensive to the insurance company who will pick up the tab. Geisinger suspected that providing care designed to head off hospitalizations at the ‘front end’ could save a lot of money and produce happier and healthier patients in the long run.
Of course, merely desiring to focus more on patient health at the primary care stage is easier said than done . Primary care physicians are already forced to see huge numbers of patients each day just to keep their doors open and earn a living. Their schedule typically allows only 15 minutes for a patient visit and leaves no time at all for follow-up and ongoing communication with chronically ill patients.
Enter the nurses.
Recognizing that physician office nurses could play a major role in solving the problem, Geisinger’s insurance operation went out and hired the additional nurses and paid for their employment. Not only did Geisinger Insurance pay for the added nursing staff’s at the physician offices they own, they also did it for physician’s offices that, while not owned by Geisinger, accepted Geisinger insurance.
The nurses would get into the mix with a patient during the patient’s physician visit. From there, the nurses stayed in touch with patients on a weekly basis, checking in to see how medicines were working, how patient’s were feeling, monitoring changes in condition, diets, etc.
The results have been interesting, to say the least.
Not only are patients staying healthier due to the reach-out efforts by the nurses, they are also finding that they are more comfortable calling the doctor’s office when they fear something is wrong, heading off more dramatic illnesses before they require hospitalization.
Rose Ann Cox, 69 years old, began working a few years ago with a Geisinger-paid nurse, Karen Thomas, to control her diabetes, talking by phone at least once a week. Ms. Cox had gone to the emergency room when her blood sugars were too low, but she has not been in the hospital for about three years now.
“You don’t always think you should call the doctor,” Ms. Cox said. But she has no qualms about reaching out to the nurse.
Via New York Times
Here’s the payoff.
In the world of health care, these numbers are huge. Who wouldn’t like to see their health care insurance premiums actually fall by 7% as a result of just this one, simple change in the system? The notion that our chances of hospitalization could fall by nearly 20% is not such a bad bonus either.
The idea is beginning to catch on as the big, for-profit health insurance companies are now experimenting with the “nurse fix”.
While the experiment of a small, Pennsylvania based health insurance company may not seem like much, the reality is that this is a very serious step forward in bending the curve of health care costs. It did not take an act of Congress or become fodder for cable television talking heads. Nobody was screaming about it at town hall meetings of hanging elected officials in effigy. No politician is going to get votes as a result of the effort.
All that happened here is that patients were cared for with greater success and a dramatically lowered price.
Health care costs are local. The sooner we recognize this, the sooner we can begin to gets our costs under control.