Health Plan That Cuts Costs Raises Doctors’ Ire

Elbert Littlefield, 76 and seriously ill with diabetes and congestive heart failure, had all but given up trying to take care of himself.

With three doctors and with 24 pills in the morning and 14 at night, he was never sure if he had taken his medications correctly and could not even list what they were. He was repeatedly rushed to the emergency room and asked for his diagnoses and a list of his medications, though, he said, “there was no way in the world I could remember.”

Now all that has changed through an innovative program that has lowered costs by, among other things, assigning nurses and creating electronic records for some patients in Bellingham and surrounding Whatcom County, in northwest Washington.

With a nurse’s help, Mr. Littlefield, of Lynden, Wash., has learned to follow instructions and take his medications properly. And his record is in a computer file, so when he sees a new doctor or goes to the emergency room, he no longer has to try to remember diagnoses or the names of drugs he cannot even pronounce.

“All I have to tell them is that I’m on the shared care plan,” Mr. Littlefield said, referring to the name of the electronic record. “There’s no more questions asked.”

But there is a catch. When, as with the Whatcom County program, medical care is improved, and money saved, there are winners: in this case, insurers, including Medicare, which could save millions, and pharmaceutical companies. And there are losers: general practitioners and hospitals, with each doctor standing to lose at least $2,000 a year, according to projections, and some doctors reporting that their costs are already much higher.

The program, which is considered a model for how health care can be improved, so far involves patients with just two diseases: diabetes and congestive heart failure. And though the organizers hoped to get doctors excited enough to make financial sacrifices to join, they were not entirely successful. Many did enlist, but one group of 60 doctors, the Madrona Medical Group of Bellingham, took part in the planning but chose not to participate in the program.

“We were seduced by the concept,” said Dr. Erick Laine, Madrona’s chief executive. “But it doesn’t work.”

The doctors were expected to purchase electronic medical records systems and to provide services that substituted for individual doctor visits, like e-mailing with patients.

The problem, said Dr. David Reuben, chief of the geriatrics division at the University of California, Los Angeles, medical school, is that “we have a health care financing system where the incentives are totally misaligned.”

This article describes a wonderful, innovative program for patient care. But as usual, everyone benefits but the physician. The program should not require a huge monetary investment from physicians.

Many physicians are participating, because patients do benefit. Physicians do care about their patients.

We need better care models. Our current model suffers for many reasons.

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1. Universal health care will require fair pay for primary care
2. Improving the quality of care
3. The complexity of health care reform
4. Primary care – money is the answer
5. Quality improving

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