Bert Caldwell: Patients, too, can lower health costs

Premera dedicated its new, $12 million building on East Sprague Avenue Thursday. The project, undertaken with the help of $700,000 in state money, will accommodate the next 200-plus workers the health insurer expects to add during the foreseeable future.

If not for the state help, those workers might have been in Bend, Ore., where Premera has a smaller service center.

The company has added 60 employees since construction was announced two years ago by President Gubby Barlow and Washington Gov. Chris Gregoire. The new hires bring to 470 Spokane’s slice of Premera’s total 3,300 employees. Most work in two older buildings on Sprague, where what was then Medical Service Corp. of Eastern Washington moved in the early 1980s.

Premera, headquartered in Mountlake Terrace, is Washington’s largest private insurer, covering 1.3 million residents.

Gregoire and Barlow returned to Spokane for the dedication. They exchanged the usual pleasantries about the building’s importance to the continuing convergence of medical services, education and insurance in Spokane. Health care is by far the city’s largest industry.

What was striking were the common themes sounded regarding health-care costs, and efforts by the state and Premera to get them under control before expenditures weaken all other economic activity.

Although the Legislature this year was able to put more money into higher education, Gregoire says health-care spending limits further investment.

With Barlow nodding his agreement, Gregoire ran down a list of measures the state is taking to contain medical costs, first among them a focus on evidence-based medicine. If a surgery, therapy or drug does not improve a patient’s health, the state will no longer pick up the tab.

Bariatric surgery, also called gastric bypass, is a prime example.

Department of Social and Health Services spokesman Jim Stevenson says only those who undergo a six-month screening process that determines whether the operation would be appropriate can qualify.

“There’s been a huge drop in the number of surgeries we endorse,” he says.

Washington will spend $3.8 billion on medical assistance, including Medicaid, this year.

The state is also evaluating clients to identify those on the threshold of developing chronic health problems, and intervening to head them off. Chronic care patients consume one-half of all health care dollars.

For the last six months, state employees have been filling out risk assessments, sort of a self-examination, with the hope they will modify bad health habits.

“It’s getting down to the fundamentals,” Gregoire says. “We want people to take responsibility for themselves.”

Barlow says Premera is also stressing personal accountability, along with broadened implementation of best medical practices, and more study to determine what those practices are.

“We want all our clients to have access to quality, affordable health care,” he says.

Premera has implemented a “Know Your Numbers” campaign that urges clients to know their blood pressure, blood sugar, cholesterol and body mass index, which measures fat in relation to total body weight. Exercise frequency is included, too. They are given benchmarks to let them know where they stand compared with recommended levels.

Employees fill out the same forms, and Premera’s annual report includes several employee profiles, with numbers. Barlow’s show slightly elevated cholesterol.

If people do not change their habits, he says, health-care costs will continue to climb at the rate of 6 percent a year — precisely the projection for Washington’s medical assistance budget — while overall economic growth averages 4 percent. That’s a prescription for disaster, he says.

The governor has read the same chart, and come to the same conclusion. The challenge now is to find, and administer, the right medicine.