Fixing a Broken Health Care System

April 9, 2009— -- Instead of consulting with their primary care doctors, many patients in this country who need medical care wind up in the emergency room.

Even the famed Mayo Clinic in Rochester, Minn., which provides quality health insurance to 130,000 employees and their families, was shocked to discover how many of them approached their own routine medical care.

"We just use the urgent care and the ER for whatever our needs were," said Cindy Hageman, a Mayo Clinic employee who works as a technician in the dialysis unit.

For some Mayo employees, the reason was simple: The ER was more convenient than going through the hassle of scheduling an appointment with a primary care doctor. But it came at a huge price -- both to Mayo, which was footing the bills -- and to patients, who were not getting the benefits of primary care, which include regular follow-ups and good preventive medicine.

"We consider if our patient goes to the emergency room, that's a failure of our system," said Dr. David Herman, Mayo Clinic medical director of employee health.

Mayo's problem, like that of many clinics around the country, was that it offered primary care using the old-fashioned model of office hours restricted to Monday through Friday, 9 a.m. to 5 p.m. Overhauling the system, the clinic took steps to make care more accessible and to control costs.

Mayo started by setting up one new department for the whole family -- combining pediatrics, family medicine and internal medicine under one primary care umbrella. They built six new family medicine centers, opened up an express care clinic in a shopping mall and started staffing physicians assistants and nurse practitioners on nights and weekends to see patients and field questions on a 24-hour phone service.

It's a model that other health care systems might want to follow.

"If we get the right person in the right office at the right time, we can help reduce the cost of care, provide quality and provide access and appropriately get referred to the right specialist," said Dr. Ted Epperly, primary care specialist and president of the American Academy of Family Physicians.

Mayo Clinic Makes Major Improvements

Mayo has been able to make these sweeping changes in care without increasing their insurance costs per patient for the past two years.

"We can take better care of patients. We can provide them better value," said Herman. "We can decrease health care costs."

Compared to the national average of employer health insurance costs, which increased from 5 to almost 8 percent from 2006 to 2008, according to the Henry J. Kaiser Family Foundation, Mayo is proving that quality care and affordability are not mutually exclusive.

After the overhaul, Hageman now prefers to go to her family doctor, Dr. Margaret Gill. Thanks to the flexibility of quick appointments she sees Gill instead of the visiting the ER . And Hageman is getting consistent care for chronic ailments such as seasonal allergies -- something she was missing in the emergency room.

For Deb Lange, a receptionist at the clinic, and her husband Dan, Gill not only coordinates Dan's treatment for colon cancer but sets up cancer screenings for other at-risk family members. Her relationship with the Lange family provides a sense of trust and ensures comprehensive care.

"It's just familiarity and continuity," Lange said on working with Gill. "You have somebody on your side."