The Spokesman-Review


Smart Bombs: Health care models here, too

If you spend any time reading up on health care solutions, you find yourself bumping into the same names. Two medical centers, the Mayo Clinic and the Cleveland Clinic, and two insurers, Intermountain Health Care (Utah market) and Group Health Cooperative, are deemed the models for a cost-efficient health care system.

Newsweek once called Cleveland Clinic “a hospital trying to become a Toyota factory.” That’s a compliment, as any business executive attempting to apply Toyota’s “Lean Six” principles can attest. The clinic won’t hire smokers and, if it weren’t against the law, would bypass obese applicants, too. Good luck finding Doritos in the vending machines. Extreme? Perhaps.

But this hospital with a world-class cardiac clinic has its heart in the right place. By controlling costs, the nation can widen access to health care without snatching scarce dollars from early learning, higher education, transportation, safety net programs and many other functions of government that have gone begging. Plus, American companies can ease the health-care-cost burdens that put them at a disadvantage with global competitors.

Seattle-based Group Health is more familiar because it operates in the Spokane market. But I don’t think it’s widely known that it’s considered a model of efficiency. Among health-care insurers in the state, it has the highest “medical-loss ratio” by a fairly wide margin. That means that more of its premium dollars (nearly 90 percent in 2010) are spent on actual medical care, rather than administration.

Scott Armstrong, Group Health’s chief executive officer, visited the newspaper’s editorial board last week and advocated for many of the reforms that were added to the Affordable Care Act. Even if the U.S. Supreme Court shoots down the law, the nation ought to pursue some of the ideas that have reined in costs for his organization and the other model clinics.

Put doctors on salary, which distances their pay from the volume of tests and treatments. Bundle payments for services, which puts the onus on health care providers to find efficiencies. Offer incentives to keep patients healthier, out of hospital beds, and away from a surgeon’s scalpel. Give patients a “medical home,” which means putting a primary care physician in charge of coordinating care.

Group Health ran a pilot project at a Seattle clinic using the medical home concept, and Health Affairs magazine reported the outcomes last year. Compared with other clinics, the prototype delivered higher quality care, greater patient satisfaction, lessened physician burnout and lowered costs.

I’ve advocated looking at other countries for health care solutions, but Group Health and the other models of reform prove they exist here, too.

Follow me. Spokane’s Lilac Parade won’t allow lobbyists for wheat growers? This is America, where corporations are people and citizens are united against Citizens United, except for the people who are corporations.

I say let all the lobbyists and interest groups in. The parade route can be renamed K Street, in honor of the Washington, D.C., address of the nation’s big-league lobbyists. Here’s a potential parade lineup:

Wheat float, followed by gluten-free diet float, followed by cattlemen’s float, followed by PETA float, followed by ice cream float, followed by health club float, followed by Chamber of Commerce float, followed by Occupy Spokane float, followed by salmon float, followed by dam float, followed by marijuana float, followed by police float, followed by risk manager float, followed by ombudsman float, followed by newspaper float, and on and on.

What could be more American than all that free speech?

Off the wall. Never knew Michael Jackson was so popular in North Idaho. A Clark Fork man was recently arrested after forcing another man to “moonwalk” at gunpoint, according to the Bonner County Daily Bee. I wonder if after the police arrived, the gunman told them to beat it.

Associate Editor Gary Crooks can be reached at or (509) 459-5026. Follow him on Twitter @GaryCrooks.

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