Self Funding Partner General Look Upstream for...
Look Upstream for Solutions to Health Care Concerns
By Melina Kambitsi, Ph.D., senior vice president, business development and strategic marketing

Employers sometimes feel like their health benefit plan is caught in the current of a fast-flowing river that’s rising rapidly.

But what if instead of being caught in the current, employers could make it to shore and work their way upstream to change health care where it starts?

Learn from an ‘Upstream’ Expert
The analogy of going “upstream” is often used by Dr. Rishi Manchanda, who takes a broad view of the health care system’s shortcomings. In his Tedx talk on “What Makes Us Sick? Look Upstream,” Dr. Manchanda notes that health care often treats symptoms without addressing the conditions that make us sick in the first place.

Dr. Manchanda will be the keynote speaker at The Alliance Annual Seminar on “Finding the Value in High-Value Primary Care” on the morning of May 21 at Madison’s Monona Terrace. The event is free but registration is required at www.the-alliance.org/events.

Dr. Manchanda is the author of the TED book, The Upstream Doctors, and an innovator in exploring the environmental and social conditions that impact health both at home and in the workplace. He is an advocate for asking patients about the living and working conditions that cause or contribute to their health care issues, and then helping patients find ways to address those conditions.

Dr. Manchanda bases his “upstream” approach on a public health parable about workers rescuing children from a river. Some workers concentrate on saving children and helping them safely cross the water, while one goes upstream to find out what’s causing the children to enter the river.

Changing Health Care Where It Starts
The Annual Seminar also features a panel of local employers who will share what they learned from offering primary care clinics at or near the worksite.

Worksite clinics can be used to deliver a wide range of health services, which sometimes includes primary care. When primary care is offered at an employer-sponsored clinic, it creates an opportunity to introduce employees to high-value primary care.

Primary care is typically delivered by physicians and other caregivers trained in family practice, pediatrics or internal medicine. This care is considered high value when it:
  • Gives more time to patients who need more care, such as people who have chronic conditions.
  • Offers quick and flexible access to care. That might mean same-day appointments; communicating with caregivers by telephone or email; or using telemedicine to reach a doctor by telephone or online.
  • Coordinates care for patients.
  • Identifies and reaches out to patients with high-risk medical conditions.
  • Provides more care at the primary care clinic when it’s right for patients, which means less care at high-cost specialty centers.
  • Refers patients to specialists who also deliver high-value care.
Paying for Value
In his Tedx talk, Dr. Manchanda also points out that health care often pays for volume — the number of office visits, tests or procedures performed — rather than paying for value. So it’s not surprising that high-value primary care typically includes a different approach to payment.

Instead of paying a fee for every service, employers who provide high-value primary care typically pay a per-patient, per-month fee. This approach increases the share of employer spending that goes to primary care, but typically helps decrease spending overall.

Employers who sponsor high-value primary care clinics save as much as 10 to 15 percent of the total cost of care after as little as 12 to 18 months. The Alliance helps employers sponsor high-value primary care clinics through their vendor partner Wellness for Life. An organization can sponsor its own clinic or work with another employer to share costs and services.

Get the Health Care System You Want
The goal of using an “upstream” approach is to get the health care system we all want: a system that changes health care where it begins.

The Annual Seminar will offer ideas and information for employers who want to be part of that change. To participate, register today at www.the-alliance.org/events. And if you can’t join us, check the website again after the event for presentations and blog posts containing highlights from the keynote presentation and panel.

It’s time for all of us to start learning how to move “upstream” in health care, for ourselves and our employees.
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