An Ounce of Prevention
Minnesota Health Plan
Information and Resources
by Senator John Marty
November 5, 2007
"If you were looking to design a (health care) system that wouldn’t work, it would look a lot like this."

Tom Forsythe
General Mills

When defenders of our dysfunctional health care system try to explain why it costs almost double what most other industrialized nations spend for health care, they often claim the higher cost occurs because we have better care. But they are wrong. Our health indicators, like infant mortality rates and life expectancy, are worse than in those other countries. Despite our excellent medical providers and medical technology, Minnesota's system is so wasteful that many families cannot properly access it, even when they have health insurance.

Perhaps the biggest squandering of money in our health care system is the failure to provide preventive care and early intervention throughout the system.

If there was a program for patients with heart failure that cut hospitalizations by 82% and reduced medical costs by half, you might expect that our health care system would immediately duplicate the program in every community throughout the state.

There is such a successful program in Duluth. Unfortunately, despite these amazingly positive results, there is no rush to implement the program elsewhere.

Since 1999, St. Mary's/Duluth Clinic Health System has been operating a "Heart Failure Program". The program treats people who have had heart muscle damage, usually from a heart attack, and are suffering from heart failure. The program intervenes aggressively to improve their health and prevent future hospitalizations.

Using a team of medical professionals including the physician, a cardiologist, a nurse practitioner and others, the program works with patients to set up a care plan that includes everything from medication and education to exercise and a change of diet. Patients receive a thorough education on what they can and must do to improve their health. They are screened for depression, quality of life, and their ability to function. Then, they are monitored on a daily basis, with weight and survey data collected by phone. When information submitted by patients shows slippage, they receive calls from the medical staff to hold them accountable for their own care plans and get them back on track.

The results are more than impressive. Although the office visits, the care coordination and the monitoring are expensive, those costs are far outweighed by the massive savings. A study of program patients back in 2000 showed that Emergency Room visits decreased by almost 9/10ths and that there was an 82% reduction in hospitalizations. For those admitted to the hospital, the length of stay decreased dramatically.

The overall medical costs for patients in the program decreased by 48%   –   almost half.

Prevention works.

So why is this prevention program only available to patients in the St. Mary’s Health System? Why isn't this intensive intervention conducted statewide for every patient with heart failure? Because under our dysfunctional health care system the program is losing money. Many of the interventions are provided as outpatient services that, unlike hospital costs, are not reimbursed by the health insurers.

Even though the program cuts medical costs by half, St. Mary's doesn't get paid for much of the work they are doing, so they lose money. This makes no sense. Yet our health care system is incapable of fixing the problem.

There are plenty of other examples of the benefits of prevention and early intervention. Chemical dependency treatment saves seven dollars for every dollar invested   –   a whopping 700% rate of return, according to a California study. Yet our health care system leaves many people who are dependent on alcohol and other drugs without access to treatment. We "save" money by not providing the treatment, but end up paying seven times as much in higher health care costs, out-of-home placements for children, and crime costs.

It is not only economic costs about which we should be concerned. As many as two thirds of our prison inmates committed their crimes under the influence of alcohol or other drugs. Estimates are that as many as 9 out of every 10 domestic abuse murders are committed under the influence. Many of those violent crimes would be prevented if everyone who needs it has access to chemical dependency treatment.

Health care reforms in recent years have focused on the misguided notion that we can save money by making it more difficult for people to access care. Unfortunately, when we stop paying for needed medical care, people don't stop getting sick. They tend to get sicker, and their care becomes more costly in the future.

As counterintuitive as it may seem, if we ensured that all people received the medical care they need when they need it, our system would cost less, not more.

The lack of preventive care is only one of the reasons that Americans pay too much for health care. Our current system is so fragmented and bureaucratic that we are currently spending about 30 cents of every health care dollar on administrative costs such as billing and underwriting costs. Most clinics employ multiple accounting clerks to handle the billing of dozens of different health plans, each at different rates for the same procedures. Health insurance companies spend many millions on marketing and underwriting costs. None of these administrative expenses do anything to improve anyone's health.

It is easy to see why the United States spends almost twice as much per person as other industrialized countries spend on health care, even though the other nations have better health outcomes. Tackling the administrative waste and other problems will yield massive savings. But there is nothing that points to the need for reform more than our failure to provide medical care up front, as soon as people need it.

The Duluth Heart Failure program illustrates how to save lives and save money. Minnesotans have the best medical professionals, the best medical facilities, and the best medical technology in the world. All we need is a medical system that enables people to access that excellent care.

jmsig.gif (2217 bytes)

 Previous issue 

Index

 Next issue 


Permission to quote or reprint material from To the Point! is granted if the author is credited.
Copyright � 1999-2018, John Marty