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 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.
[By JAN YOUNGQUIST]
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