Monday, August 18, 2014
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Logan County Board to vote on mobile lab service
Local providers ask support for present integrated healthcare system

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[August 18, 2014]  LINCOLN - At last week's Logan County Board workshop, consideration to offer county employees "wellness checks" through a mobile lab was strongly debated.

Last month the board opened the discussion, but the matter was tabled, providing an opportunity to hear opinion from the local medical community on the potential impacts of adding such a service.

On Thursday, the proposal received a firm thumbs down from local health care providers who cited national models on healthcare systems, costs, potentials for disconnects in individual patient care, strengths of the locally integrated system and a call for support for the current system.

When Logan County employee health insurance costs skyrocketed a few years ago, it was primarily attributed to high medical costs for a few employees with catastrophic illnesses.

Insurance and legislative chairman, Jan Schumacher said the insurance committee is always looking for ways to benefit county employees’ health. She added, "The healthier your employees are, the fewer the insurance claims."

Schumacher said that the county's insurance consultant, Nancy Schaub at R.W. Garrett, had brought forward information for the county consider. The county's health insurer, Blue Cross/Blue Shield, contracts with a service that provides lab and counseling services for a wellness program.

Catapult Health would bring its wellness center to the courthouse. The mobile lab unit offers basic lab testing, diagnostics and patient assessment provided by a nurse practitioner, as well as other types of health counseling. The service includes assistance in setting up appointments with the patient's regular family doctor when additional or more advanced medical care is needed.

On Thursday when the full board met for discussion, Regional Administrator for Memorial Physician Services, Susan Shawl, and local physician Dr. John Wahab came before the board. The explained a number of reasons that they would not recommend the use of a mobile service.

The two cited a variety of reasons that included -- unproven results of improving patient health, lack of continuity and historic record keeping due to the temporal nature of these services and the lack of connectedness to the system here; and they say it will likely result in greater costs to the insurer, the county, down the road.

Model health care system in place

Dr. Wahab said that the model of healthcare collaboratively developed between the health agencies that now serve the Lincoln and Logan County community is "Patient centered health." There are national guidelines for this and both Memorial Services and Springfield Clinic, who work collaboratively have achieved Level 3 standards in the model, the highest in the country. It includes recommended screenings and healthcare.

"Studies show that when you have a patient centered healthcare which is directed by 'a' physician who is involved in every aspect, patients are healthier; they have less hospitalizations, less E.R. visits, healthier patients," Dr. Wahab emphasized.

Medical systems integrated to a top hospital

He reviewed that here in Lincoln and Logan County we have one of only 60, critical care access hospitals in the country; and we have access to more than 60 specialists that come here; and an integrated health care system that follows patient care - an important aspect of long-range health and wellness.

Dr. Wahab cited various examples of how their system works with tests and procedures, and that record keeping follows patient care from the immediate to over time. This includes historic records for reference, as well as automated reminders that it is time for a patient to come back and get checked. The whole system is set up to aid in coordination and to follow patients care.

He identified as his primary objective for coming forward to speak as support of the integrated, comprehensive system as what is 'proven by studies' to be the best for patient health.

When it comes to costs, he said, "There are multiple studies that show when you have this type of system set up you decrease the costs of healthcare," he said.

Discontinuity in patient care

Dr. Wahab also observed other factors of concern if a service is used that is outside the local health care system. He said that there is often a discontinuity when patients get care outside the system, particularly when it could be from a service that won't be there in 10 years. He has seen that happen in his practice already. Patients had tests performed and the service that was there a few years is gone, and the records can not be found. He has also had patients come to an appointment and forgot to bring their lab results from an outside source.

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Victim advocate for the state's attorney's office, Lisa Bobb said that she has had that kind of experience. She had a mammogram created by a mobile lab at her work place in the 1990s, and now those results, when they could be useful, can no longer be found. She also inferred by comparison to her old computer that is gone, that it is now bothersome not knowing who might have access to those medical records.

Support of current medical system important

It is a pivotal period in the history of the medical community, not only here in Lincoln and Logan County, but for small communities everywhere. There are too few doctors here now, Dr. Wahab said, and there is an attempt being made to draw new doctors to the area. It would be better to show new candidates that are being interviewed that the system that is here now has the support of the community, he said.

Board members cite attractiveness of on-site lab

County board member Kevin Bateman spoke in support of the county employee mobile wellness center, saying that it may provide earlier detection of a health problem such as diabetes or get help for a substance abuse that some county employees might not seek out otherwise.

Finance chairman Chuck Ruben added that the service is being offered at no extra cost to the county through its insurer Blue Cross/Blue Shield. In recognizing early detection of a health matter, he said, "They know actuarially that if they can get those people in and get them treated, their costs go down."

Last arguments from both sides

Dr. Wahab responded, "It’s a great idea, but it doesn't get people through the doors." He added, "But, is there any data that proves it works? The model we have set up in Logan County, and we are following, does show that you have long-term benefits from doing it. Why do it twice, it doesn't save money in the long-term."

Shawl said, "Our goal is for preventative care as well. We want patients to get taken care of."

And when it comes to costs, she doesn't believe there will be a savings. "It sounds like a great idea. Right now it is free to you, and that's a great deal. "But," she believes, "ultimately it will raise the costs of health insurance down the road."

Shawl said, "We want local support. We want to be here in the long-term. We are committed to doing that."

Shawl concluded that the proposed services would fragment patient care. Dr. Wahab affirmed, "The follow up is just not there."

Further discussion revolved around liability on the county. State's Attorney Jonathan Wright said that he had come to the meeting to hear what was said because he just didn't know enough to say if the county could be held liable or not in any way, such as if a patient didn't follow through for medical care after tests, etc.

Insurance chairman Jan Schumacher said that on Tuesday she would move to take the measure off the table and then make a motion to recommend offering Catapult Health wellness services to county employees.

In the original motion, there was an incentive to offer employees a $10 gift card for taking active measures for their health. This was debated between board members with one suggestion to offer the employee a $10 gift certificate with proof after seeing any healthcare provider for an annual wellness check-up.

Straw votes were conducted on the motion and several amendments with mixed, unknown yes or no results.

Ten board members were present with two, Andy Anderson and Andy Meister, absent. Anderson was out for health reasons. At the end of the meeting, Chairman Bob Farmer announced that Meister is resigning due to moving outside the district (Mount Pulaski area) that he represents.



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