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1. 

   Paul Grundy

   May 25th, 2009 at 1:24 pm

   1

   Corporate Concierge Medicine

   The folks at the White House think that large employers can somehow now buy healthcare much better than government can. I have tried to explain that government so tilts the payment system in how it buys Medicare that we the employer buyers can only buy the care that Medicare buys – at least that is true in the ASO fee for service market. It is true in the intergrated HMO market like Kaiser we can do much better but that is only about 10% or less of the care we can buy. The government spend which, is about half of the dollars in health care, locks us into the CMS episode based PPO buy system that frankly rewards, abuse, waste, excess care ,even toxic care.

   It is true that some companies have built their own corporate concierge care and opted out of the ASO system. Companies that are in specific geographic areas like Harrah’s in Las Vegas paid top dollar to hire the best primary care doctors to provide direct care to their families and this did work will for Harrah’s, Perdue, Caterpillar, Intel. Better up stream care, primary care, prevention results in savings but it further fragment care for the whole community and it does not work for an IBM with employees in every zip code unless we were willing to treat 60% of our employees diffrently from the 40% that are in large groups. In Reno for example this corporate concierge play on the part of Harrah’s almost completely dried up the availability of primary care for IBM’s employees to say nothing of our mothers and fathers in Medicare. As a buyer of care only 5% of our total healthcare spend is on primary care and it is the best bargain we get. However, our ability to buy meaningful primary care in the structure built on how Medicare buys care is very bad and getting worse.

   IBM did think about corporate concierge Medicine but rejected that play!! If we fail to change the system for all of us believe me we will look at that option again.

   But, sadly the other option will be for more jobs outside the USA where either healthcare is not such garbage or is a whole lot cheaper or both.