Niche Services vs. Coordinated Care

Recently, I got three calls from three vendors offering three wonderful services for our members. The first vendor offered the best price to encourage our members to complete their Health Risk Assessment survey. They promised a 60% completion rate for eligible members for the lowest price. Terrific.

The second vendor promised to do everything necessary to get biometric screenings done for more than 50% of the adult members of the Colorado HealthOP. They would go to them or send them to their “local” labs. And when I described that our membership includes people in a small town in rural Colorado, the vendor answered that these individuals could just stop by their lab the next time they are in the city.

The third vendor assured me the best volume discount available at grocery store-imbedded small clinics. Three great vendors were offering me three great products at three great prices.

The American healthcare system is a wonderful place for niche for-profit entities to crop up and take advantage of an uncoordinated system. There are hundreds of small (and some large) profit centers that take advantage of the lack of coordinated healthcare.  One can start up a small business that can expertly solve one problem. For instance we recently spoke with a biometrics company; they do biometrics like a well-oiled machine–height, weight, blood tests, etc. Just go to their shop and get it all done. Or they can come to your worksite and check all of your employees at one time.

In an uncoordinated system this works great. It gets the job done with volume discount prices, members get the product or service they desire, and the vendor — often a small business — makes a profit. In an uncoordinated system it is okay to have separate entities provide their slice of the healthcare pie. The health risk assessment data is held in one shop, the biometrics data is held in another shop, and the convenient small clinics program is held in yet a third shop. The member can go to each individual shop and get the individual service.

But in a coordinated and integrated healthcare system, these niche markets are unnecessary and maybe even dangerous. They certainly do not promote an integrated primary care home. Barbara Starfield, MD has studied the benefits of primary care all over the world and in the United States.

Primary care works. It provides comprehensive care for most of the people, for most of their problems, most of the time. And it uses integrated information in the context of a personal relationship to improve health, decrease cost, and improve the patient experience. Primary care is the triple aim. And primary care won’t work in an uncoordinated environment.

There are dozens of goods and services that get niched and sold by vendors to unsuspecting and well-meaning health insurance companies, employers, and patients.

• Health Risk Assessments
• Wellness programs
• Disease management
• Health Screenings
• Health Fairs
• Biometrics
• Patient education
• Text Messaging
• Care coordination

Yes, these vendors can make each one of these individual goods and services cheaper. But, because they are not provided in the context of a personal relationship with a primary care home, they ultimately don’t save money. The work of getting the information from each place to the patient and primary care provider is expensive, time consuming, and fraught with mistakes, duplications, and omissions. The data is just not where it needs to be when it needs to be there.

We are committed to investing in primary care. We believe that this investment will pay off with improved member health, lower costs, and happy members. That’s what the research shows, and that’s our aspiration.

Yes, we have vendors that provide services to our medical providers and members. With careful consideration of the impact on the members and providers, we weigh the risks and benefits of certain niche vendors. We have chosen some products and services; we have rejected others. We work diligently to assure that the vendors, products, and services we do purchase are directly aligned with our goal for integrated primary care.

Integrated primary care takes extra work, time, and resources. We must resist the urge to jump on every niche product that might save us some money this year because we are investing for the long-term and want to help build a coherent and cohesive integrated system of care for our members.

by

Jack Westfall, MD, MPH

CMO, ColoradoHealthop