I cannot begin to count how many times employers have asked me how they can control health care costs.
Over the years, I have tried to sound intelligent and respond with the latest and greatest academic responses that make me sound like an expert. However, I have concluded that the only way to control medical costs is to focus on the primary care exam room.
The most impactful decisions on the ultimate cost and delivery of care are the discussions occurring in the primary care exam room. The best primary care exam services are delivered by primary care practices which are certified as Patient Centered Medical Homes (PCMH).
PCMH is a Model, Not a Place
PCMH may sound like a place, but it is not. PCMH is a model of the organization within a primary care practice that incorporates many features that are above and beyond typical primary care practices.
It includes a comprehensive care model that takes into account all of a patient’s physical and mental health care needs, including acute and chronic issues. These services are generally provided by a team of providers including:
- Physicians assistants
- Advanced practice nurses
- Patient centered behavioral health therapists
- Clinical pharmacists
- Care coordinators
- Support personnel such as nurse educators and social workers
These practitioners provide personalized relationships with patients and their families to help them understand how to manage their care. If a patient requires some level of specialist care, the PCMH team coordinates care and follows up with the patient, specialist and hospital. This level of involvement assures a smooth transition of care for the patient through the complex medical system.
Achieving High Levels of Care
To achieve this high level of care, the PCMH team needs to be accessible to all patients with shorter wait times than typical primary care practices. It is essential that the PCMH team provides around the clock availability through a variety of electronic, telephonic and virtual communication opportunities.
Three Levels of PCMH Certifications
There are three levels of PCMH certifications, with Level 3 being the highest available.
In the Dane County area, the only Level 3 PCMH certified medical practices are the clinics of Group Health Cooperative of South Central Wisconsin (GHC-SCW). GHC-SCW focuses solely on the delivery of primary care and delivers a system of advanced primary care.
These additional clinical services include:
- Sports medicine
- Behavioral health
- Physical therapy
- Optometry services
- Complementary medicine
All of the services above are available at the convenient clinic locations throughout Dane County.
Offered Through The Alliance
Primary care at GHC-SCW is not simply a mechanism to refer patients into an expensive medical system, but it is a holistic approach to delivering medical care in the least expensive setting – the primary care exam room.
All the GHC-SCW clinics are available to Alliance members and all members are invited to try what it means to have a Level 3 PCMH experience. In fact, patients should be encouraged to ask their current primary care system why they are not certified as Level 3 PCMH.
Al is the Chief Insurance Services Officer at Group Health Cooperative of South Central Wisconsin (GHC-SCW). He has the primary responsibility for the oversight of the insurance programs at GHC-SCW including marketing, sales, product development, pricing, underwriting, provider contracting, communication, advertising, public relations, government programs, and customer service.He oversees, manages and provides direction in the development and execution of insurance programs and initiatives in conjunction with the GHC-SCW strategic plan and goals. Al has seen incremental growth in membership of GHC-SCW since joining the organization in 2006 from 53,000 members to now over 75,000 members in 2018.
Al has been involved in the Wisconsin health insurance industry for over forty years and has seen significant changes in the industry over the years.He had a long and rewarding career at Blue Cross & Blue Shield United of Wisconsin (BCBSWI) which spanned the decades of the 1970’s through 2006. During that time, he worked principally in a variety of management positions ranging from internal operations to more externally focused areas in various sales, sales management, and executive positions at BCBSWi until his departure in 2006. His tenure at BCBSWI allowed him to develop over the years in a variety of positions which allowed him to understand the importance of the industry in providing exceptional service to all employers and their employees. A lesson that has he has continued to embrace at GHC-SCW.
Education and Associations:
Al graduated from the University of Wisconsin-Milwaukee and attended graduate school at the University of Wisconsin-Milwaukee. Al is a fellow in the Life Management Institute. Al in the past has served on the boards of the Juvenile Diabetes Research Foundation of Western Wisconsin and continues as an Ambassador, the Cooperative Network Board where he represented the health sector for cooperatives in Wisconsin and Minnesota, the Wisconsin Association of Health Underwriters (WAHU), including Past President, and the Madison West Kiwanis Club, including Past President. In addition, Al has previously been a member of the Fond du Lac Area Businesses on Health Board of Directors, as well as a member of the Fond du Lac Rotary Club. Al believes sincerely in the value of community involvement in civic, professional, and business associations and continues to look for opportunities to serve in the community.
Blog posts by Allan.
Latest posts by Allan Wearing
- Why Controlling Health Care Costs Starts with Primary Care - January 2, 2018