Thinking differently about health care

By Victor Mitchell gazette.com

The technology innovators at Apple once urged consumers to “Think Different.” It was just an advertising slogan, but resonated deeply with consumers looking for technology solutions. We need that same spirit when it comes to health care.

Instead of getting stuck in the binary choice between Obamacare and Trumpcare, we must look at other more innovative options. Most especially, we need to look outside the traditional model of insurance being the foundation of health care and consider the potential of an alternative system built around a network of nurse practioner-managed primary care clinics.

This came clear to me last fall when my wife and I visited Health Wagon in southwest Virginia. My wife and I had previously donated to this organization, and we wanted to see for ourselves a different approach to health care.

Health Wagon’s mission is, in its words, “to provide compassionate, quality medical care to the medically under-served in the mountains of Appalachia.”

It does that through two clinic facilities and a mobile unit. The staff is lean, just two doctors of nursing practice, a family nurse practitioner, two registered nurses, three licensed practical nurses, an outreach coordinator, a director of operations, an administrative assistant, a director of development, a data systems coordinator and a receptionist. That’s it. And they serve upwards of 12,000 patients each year, for just $10 a visit maximum.

Many specialty screenings are totally free. No insurance is accepted. And for these low out-of-pocket costs, clinic patients receive a full range of diagnostic and preventive care, including a telemedicine link to the University of Virginia Health System for advanced diagnoses and treatments.

In partnership with pharmaceutical companies, Health Wagon gets its patients’ prescriptions at deeply reduced costs.

Health Wagon is obviously not for everyone. It is designed to serve an impoverished and remote part of Appalachia. But some of the principles of the Health Wagon model could be broadly applied here in Colorado.

First, the clinic model is a practical and cost-effective plan for rural and poor residents, who often cannot afford even the co-pays to use their present health care plans. In parts of Colorado, we are too dependent on treating primary care cases through costly hospital care and high deductible insurance plans.

The recent legislative creation of a special enterprise to pay provider fees for care here illustrates the way-too-overpriced path we are on here. It even threatens the sanctity of our Taxpayer’s Bill of Rights, TABOR.

Second, Health Wagon teaches us that most primary care functions can be competently treated by nurse practitioners, backed up by telemedicine and specialists. What I witnessed in Virginia was almost a miracle. The mostly female medical and nursing staff was delivering quality care and compassion that we typically don’t see, even with high-priced insurance plans. Patients were given 45 minutes of attention each. It was amazing. I came to feel that 45 minutes with a skilled nurse practitioner was a far superior experience when compared to a brusque 5-minute encounter with an MD, one that many of us wait an hour to see.

Third, Health Wagon does an effective job of leveraging charitable support for its health care programs. They don’t wait on the government to rain money from the sky. They create their own opportunities through effective development strategies.

Health care reformers should never pursue a “one size fits all” solution. It just won’t work. Consumers need choices that “think different,” offering distinctive options for myriad situations. It’s clear that our present insurance and hospital-centric system is not offering the options that many need or can afford. It’s also clear that under the “Unaffordable Care Act” the insurance companies and drug companies have made a lot of money. They don’t want anything new that threatens their “honey pot.” The clinic model would bring some much-needed change to this monopolistic status quo. Let’s give it a chance.

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