Creating opportunity
WellMed’s Pioneering Approach to Medicine
Free Enterprise Staff | August 13, 2015

This is the second in a two-part series, the first of which was published yesterday.

Keeping Costs Down—and Quality of Care Up

WellMed isn’t beholden to the same kind of players that routinely hold sway over other health care providers. Say you’re a physician who works at a hospital or a medical group organized around an insurance company, and a patient comes in who requires a certain procedure or would benefit from seeing a specialist. Clinicians in these kinds of settings might only be permitted to refer patients to in-network specialists, or the recommended method of treatment could be denied based on price.

Yet it’s this sort of short-term thinking that often leads to higher costs. If a patient doesn’t receive the necessary treatment at the beginning stages of an illness, then costs often mount over the long-term, as hospital readmissions and complications arise.

“We don’t have to send patients to our own network or a certain specialist employed by a certain hospital,” Hernandez says. “It’s about having the freedom for the primary care physician to deliver what she thinks is best at the point of care to her patient—whatever that may be.”

Providing Physicians With Tools They Actually Need

WellMed applies the same holistic ethos toward the information it supplies its physicians, Grundhoefer says.

“We provide our doctors information about all the claims paid out and data from all hospitalizations and lab work,” he says. “Our closed loop system also offers visibility into pharmacy data that we feed back to our primary care doctors, so they truly have an entire view of a patient’s history—where they’ve been, what medications they’re on, how their health has improved or worsened.”

WellMed’s pharmacy data is particularly useful. While most doctors are only aware of the prescriptions they’ve written, WellMed physicians also have insight into whether their patients have actually filled those orders.

It’s hard to downplay how significant this piece of data is for clinicians. Researchers estimate that 90 million Americans—approximately half of all adults—don’t fully understand their doctors’ instructions regarding the medications they prescribe. A Canadian study published in The Annals of Internal Medicine similarly found that roughly one-third of all prescriptions went unfilled.

WellMed’s physicians aren’t racing against the clock to see more and more patients. They rather have the ability to methodically review each patient’s individual health record, adjusting his or her treatment plan accordingly. Because practitioners sit at the center of the health care equation, WellMed PCPs are able to immediately follow up with their patients when warning signs—a prescription that’s gone unfilled or a missed follow-up appointment with a specialist, for instance—emerge.

“The idea is that, if you arm the PCP with the information he or she needs to make an informed decision on the care of his patient, that’s what really drives outcomes,” Hernandez says.

Results That Stand Out

The system works both ways. Like any physician, WellMed PCPs want to provide the best possible care to their patients; yet unlike many of their peers, they are actually incentivized throughout the course of treatment to do just that. Driving this, Grundhoefer says, are such factors as WellMed’s unique compensation policy and its long-term view of managing a person’s health. “We have positioned ourselves to assume complete responsibility for a patient,” he says.

“When a 65-year-old first walks in, PCPs are viewing their relationship with that patient through the lens of, ‘If I do a great job for this patient by providing great service, then I’m going to have a 20- to 25-year relationship.’ It’s therefore in both the PCP’s and the patient’s best interest—financially, morally, ethically, and health-wise—to invest in that relationship upfront. It’s in that way that PCPs can realize these long-term relationships.”

Such is the reason why the vast majority of physicians devote their lives to the practice of medicine. WellMed simply supports them throughout their careers to help them achieve this goal.

As WellMed continues to attract more physicians and patients, it and other ACOs stand to have a transformative impact. These organizations are, after all, helping people live longer, healthier, and more productive lives, and they’re saving a substantial amount of money. With upward of 80% of all health care spending going toward Americans with one or more chronic illnesses, there’s literally trillions of dollars at stake. The question is, what model will prevail?

A Unique Future That Resembles the Past

WellMed sees plenty of opportunities to expand in Florida and Texas, two states that have a disproportionately high number of elderly residents. The organization is also open to treating younger patients, a group it’s already beginning to tap into. “But it’s not like Walmart,” Hernandez says. “You can’t just open the door and hope people show up. You have to be well planned, well positioned, and have a good paying partner to make sure that we can be successful. There are others out there trying to do the same thing.”

WellMed is, in many ways, emblematic of a wider trend that promotes a back-to-basics lifestyle. After years, and even decades, marked by a ‘more is better’ mantra, Americans are finding comfort in simplicity, whether it’s in their choice of electronic gadget or their living room couch.

WellMed fits into this broader cultural movement. It’s not peddling some revolutionary new technology or a health care silver bullet. At its core, it’s simply following a basic, targeted health care model, one that’s been around for a long time but is rarely acted upon.

The approach has struck a chord, especially recently. Fifteen years ago, WellMed had some 10,000 members, a figure that climbed to roughly 90,000 by December 2013. In the 18 months since, WellMed’s patient population has grown 80%, Grundhoefer says, to 180,000 members. It has also added five markets to its territory during that time, with its number of owned clinics increasing by 30%.