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The Answer For Lower Healthcare Costs Is...

...Customer Service.

From the New York Times: Seattle's Iora Primary Care is a new model of primary care, seeking national scale and venture capital funding.  Though the ambition may be outsize, the concepts are not new. Daily team huddles. Health coaches. Taking satisfaction surveys seriously and mining results for actionable insights. Employer and payer partnerships. Pay-for-performance not volumes. Loose-tight operations (wellness options are "loose" - i.e. varying from site to
site, while EHR alignment is "tight" and non-negotiable.)

According to the article:
"...small change(s) can make a big difference in a patient’s health — what good is the perfect drug if the patient can’t swallow it? — but the extra-mile work it took to get there can be a challenge for the typical primary care practice in the United States. Harried by busy schedules and paid on a piecework model, many doctors rush from visit to visit, avoid phone calls and emails that don’t generate payments, and often fail to address the complex social issues that hamper people’s health.
"This misalignment of financial incentives is a huge problem for patients, who often can’t get the care they need. But it’s also a big economic problem. The United States has the costliest health care system in the world, even as many patients suffer from preventable illnesses and die younger than their peers in other countries. The system is so full of inefficiencies that Americans are often sicker even as everyone — patients, insurers, the government — ends up spending more money on care.
"Iora thinks it may be able to solve both problems and make money doing so. Its business model is meant to keep patients...out of the hospital by improving service while earning a dividend on the expensive care it was able to avoid."

Still, despite the intuitive appeal and some preliminary research, hard data on results are scant:
"Iora has little published research on the cost savings it has achieved for its partners. The company’s small size makes it hard to produce data with statistical significance. Asked about current evidence of the model’s success, the company provided numbers about one of its sites, where researchers have compared Iora patients with similar patients elsewhere: Total spending was down 12 percent, with hospitalizations down 37 percent, compared with the control group. That may have been a practice with healthy patients, like Dartmouth, or one of the higher-risk patient groups; an Iora spokeswoman said she could not say which practice it was because of a confidentiality agreement with the sponsor.
"Many of the basic elements of the Iora primary care approach — longer hours, more support staff and additional per patient funding — have been tried in other settings, especially in so-called patient-centered medical homes. So far, the results for those types of practices have not been promising. Few have shown real reductions in spending or in the frequency of patients entering hospitals.
Many healthcare organizations are chasing the same vision, betting that all the "We Love Customers" talk will finally start to put some results on the bottom line.  As a healthcare strategist AND an occasional patient, let's hope they're right and the data begin to show it.

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