Spokane Journal of Business

Trying to solve the affordability puzzle at Group Health

Cooperative's strategy targets big cost savings to help it achieve goals

  • Print Article
Trying to solve the affordability puzzle at Group Health

Like all other health care organizations, Group Health Cooperative is facing a radically changing health care market and the pressure of rising costs. But from chaos, comes opportunity. We are adapting in ways that put our patients' needs at the core and ultimately bringing more services to our members.

Last fall, Group Health Cooperative faced a significant financial shortfall for the year if we didn't act swiftly to modify our budget. Soaring labor and care costs and higher-than-expected fees from contracted providers and hospitals had put our organization on alert. We recognized that things must change. The status quo was no longer sustainable if we wanted patients and employers to afford our care and health plan products.

Taking thoughtful, cost-saving steps, we ended the year in the black and today we continue to seek efficiencies. We are benchmarking our cost structure against other elite health care organizations in the nation, and in 2013, we intend to capture $150 million more in cost savings. Out of the savings, Group Health will make critical investments to improve care and access for patients and to alleviate rate increases for premiums in the coming years.

In Spokane, we plan to keep growing Group Health's presence and are building out a local, integrated medical neighborhood that assures coordinated care across the continuum of settings. We're also enhancing services so that our patients can get the health services they need when they need them, especially in primary and urgent care.

Growing presence

Group Health is proud to be affiliated with Columbia Medical Associates, whose doctors joined our medical group in 2011. Columbia is a multispecialty medical group with 40-plus doctors serving 65,000 patients in 12 locations. This arrangement has doubled the number of Group Health primary-care providers in Spokane.

Working together allows us to provide better care and service for our patients because the two organizations can learn from each other. Group Health excels at managing care for populations of patients, and our Medicare plan is ranked among the top nine in the nation. Columbia knows how to provide high-quality care in an open system working with multiple payers. We are sharing best clinical and business practices so that we can serve the Spokane community more affordably.

High-end medical imaging is just one example where having a larger-scale system helps lower health care costs. An MRI or CT scan is expensive, and the cost varies in the market. Previously our patients' scans were performed at various locations throughout the community, but now, most of these tests for Columbia and Group Health patients are performed in-house at Columbia's imaging centers, where we also work together as a clinical team so the patient gets the right test at the right time.

The medical neighborhood

We believe the care we provide is higher quality and more affordable when it is coordinated between all members of the health care team. Last year, Group Health Cooperative and Providence Health Care formed a limited liability corporation to establish an integrated delivery system where primary-care doctors, specialists, and hospitals will work more closely together to coordinate care for patients. We expect that the quality and cost of care will improve as our clinicians share medical records and follow standard protocols for care. Fewer tests will be repeated because the doctors will see the same records and communicate more reliably with each other about their patients' needs.

Primary and urgent care

In recent years, Group Health had been seeing a spike in the number of our patients who were going to hospital emergency rooms. Many of the visits were for conditions that could have been treated in primary care, and we recognized an opportunity to improve our access.

Since Jan. 2, Group Health has extended clinic hours from 7 a.m. to 7 p.m. at Riverfront, Lidgerwood, and Veradale medical centers to accommodate time-strapped patients. Through smart planning, we've made this change without adding staffing costs. Columbia Medical Associates is also expanding its clinic hours to include evenings and weekends.

Staying open longer makes it easier for people to go to their medical appointments without missing work. It helps lower costs for everyone because when people get their problems addressed in a primary-care setting, fewer wind up in emergency departments where the cost of care is much higher.

We're also partnering with Providence so that our members have more choices for urgent care, thus avoiding costly emergency departments. Providence and Group Health have combined resources and expertise to serve our patients together. Providence is opening its second urgent care facility this July at Fifth and Division, and it will be open every day from 7 a.m. to 11 p.m. Doctors with Group Health Physicians will be working side-by-side with physicians from Providence Medical Group at this facility.

Medical home

This year, we will roll out a more affordable medical home model in our clinics that we call Medical Home 2.0. Research shows that providing a medical home to patients leads to fewer hospitalizations and higher patient satisfaction.

In a medical home setting, patients receive proactive primary care, and their doctor-and-care team takes the time to get to know their patients' unique needs.

With 2.0, our doctors and care teams will be better equipped to serve more patients without compromising quality. It also prepares Group Health to care for a growing number of Spokane-area residents who will become eligible for coverage through the Affordable Care Act. The physicians at Columbia will add medical home features to their practices as well this year.

Spokane is truly on the leading edge of Group Health's efforts to solve the affordability puzzle for our members. While maintaining our top-quality systems of care, we are enhancing our service and access for members and working with Spokane-area providers in unprecedented ways. We are excited to be working with great community partners and look forward to growth and expansion as Group Health becomes more visible to employers and consumers as the year unfolds.

We have a vision: We want Spokane residents to have health care they can trust that is both affordable and high quality. We want your primary care team to be accessible when you need us and to have reliable urgent care after hours. This future is possible, and we are creating it now.

  • Kelly Stanford

  • Follow RSS feed for Kelly Stanford

Read More

Sign up for our E-mail updates

including the
Morning Edition

Join our list