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’60 Minutes’ On The Health Wagon: Bandaid For States Not Expanding Medicaid

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Dave Chase — Forbes.com

In today’s 60 Minutes they highlight the Health Wagon, where nurse practitioners are providing badly needed healthcare to the uninsured working poor in Appalachia—it’s what 60 Minutes calls “medical mercy for those left out of Obamacare and ineligible for Medicaid.” It’s difficult to find fault in the compassionate health professionals highlighted in the segment. However C.K. Prahalad, author of Fortune at the Bottom of the Pyramid, suggests there’s a more sustainable approach. Prahalad stated the following:

If we stop thinking of the poor as victims or as a burden, and start recognizing them as resilient and creative entrepreneurs and value-conscious consumers, a whole new world of opportunity will open up.

I wrote earlier on how a Nobel Prize winner is taking a do-it-yourself approach to health reform to address the working poor ineligible for Medicaid. Forbes contributor Roger Trapp expanded on this approach in “Starting Small Could Be Key To Doing Business At The Bottom Of The Pyramid“:

“A core principle is understanding that business and social conscience need not be opposed to each other. Pamela Hartigan, director of the Skoll Center for Social Entrepreneurship at Oxford University’s Said Business School, told the Financial Times earlier this year that it was important for business schools to give people with “world-changing ideas” the skills to be successful business leaders. At the same time, of course, the people with these ideas need to realize that having the right skills is as important as the passion and the inspiration in turning a dream into a reality.”

The American branch of the organization Nobel Prize winner Muhammad Yunus founded is led by Andrea Jung. Grameen America’s Jung was named one of Forbesmagazine’s 100 Most Powerful Women in 2004. In 2009, Forbes ranked her the 25th most powerful woman. They are taking a classic disruptive innovation approach as I outlined earlier.

“Having heard Clay Christensen expound on disruptive innovation, it shouldn’t come as a surprise that change always comes from outside of incumbent players. While health orgs are dooming their innovation to failure or dither by not taking any meaningful action, it’s notable that a Nobel Peace Prize winner sees an opportunity to fix a critical portion of the U.S. healthcare system. As any good entrepreneur would do, Yunus identified an unmet need and so Grameen created an offering tailored to their target customers.”

Grameen PrimaCare wisely partnered with Iora Health, which has demonstrated they can make their model work in every imaginable setting, serving union members, university employees, consumers in the individual exchanges and Medicare recipients. I had the opportunity to visit the Grameen VidaSana clinic. Like every other Iora clinic, it’s clear that over-achieving on Quadruple Aim objectives that are central to their approach. Community leaders in those areas should look at how their communities can be better served with this radically better (and more affordable) option.

The irony is these very low-income individuals are getting superior primary care to what 99% of Americans getting—rich or poor. I put my own family where my mouth is, as Iora opened a Medicare Advantage program where my parents live. While it wasn’t easy to convince 80-somethings to change their insurance and doctor, they couldn’t be happier 15 months after making the switch. Despite having been in a rich teacher-retirement benefits program that paid for Medigap coverage and going to a well-regarded Seattle multi-speciality clinic, a “rich” program in a flawed payment and delivery model is poor. Iora’s Net Promoter Score (NPS) is nearly double the highest NPS of any traditional healthcare provider (Cleveland Clinic has the highest score). Every time I visit with my folks, they bring up how they’d be testimonials for Iora.

It is critical to point out that the Grameen clinic serving the low-income population charges their patients. Despite their low incomes, the members realize that it’s money well spent if it allows them to avoid missing work. They must watch every penny and yet they deem it worthwhile. Like their microfinance program, this program isn’t designed as charity. Rather, Grameen members pay $10 per week and relieve a burden on the system as a whole.

The members, many of whom are undocumented workers, fall outside of what Medicaid and Obamacare address, so the rest of the healthcare system is quite happy to keep these individuals out of the ER or even federally qualified health centers. Grameen’s “competition” will be the ER and FQHC, so they must demonstrate that higher level service and dealing with the same healthcare team provides distinct advantages over disjointed (though often free) care in the ER/FQHC.

The value-based primary portion of the Health Rosetta is being adopted around the country. As I’m speaking around the country, it’s clear there is real hunger for approaches far more effective than the past. Business coalitions are helping their members revolutionize their health spending. Just this past week, I keynoted an event with 100 business leaders gathering at their state capital. This famous scene from the movie Network is the best way to describe their level of angst.

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