What's old is new again: Employers, in an effort to cut back on workers' nonurgent emergency room visits, have begun contracting with Carena, a Seattle-based company that boasts a network of physicians that make house calls. Among the employers signing on to Carena's modern-day Rockwellian brand of health care is Microsoft.
"Looking at our ER department utilization rate, we realize we had a significantly higher-than-benchmark number, and a lot of it stemmed from nonemergency, unnecessary and inappropriate ER visits," says Julie Sheehy, group manager of U.S. benefits at Microsoft.
According to 2004 research by the Centers for Disease Control and Prevention, only 13% of visits to the ER are considered necessary. Most incidents were minor cuts, high fevers, back pain, nausea and vomiting, all of which could be attended by a primary care physician if one was readily available. Research reveals that Americans made 25% more ER visits in 2003 than 1993.
"We were looking for a measure that would help us to address the issue," Sheehy says. "The company did not want to implement a copayment."
With a copay, Microsoft officials felt, some workers might be steered away from the ER, but that solution probably would not address the underlying reasons people were going to the ER in the first place, such as poor access to primary care physicians. "At Microsoft, we really pride ourselves not only in being creative and innovate with our product development, but also in the benefit arena as well," Sheehy says.
Ralph Derrickson, president of Carena, explains, "When employees can't get an appointment with their primary care physician, or if they don't have one, they go to the emergency room." However, he notes, "that's the most expensive and least effective place for care of non-life-threatening injuries and illness." He believes Carena's program allows employers to reduce their health care costs while at the same time increasing the quality of care and education for their employees and families.
No paper gown necessary
For a house call, an employee contacts Carena's nurse hotline, where a nurse will triage the situation. If the condition is deemed urgent, but one not for the ER, and the employee does not have access to immediate medical care, the nurse hotline representative contacts a Carena physician for a house call. All Carena physicians are board-certified.
"Most people do not want to go to the emergency room because it is not a pleasant place and the wait is long. Sometimes you have to bring your children because you were unable to find someone to look after them, or your children are being treated, which is unpleasant as well," Sheehy notes. "I know it's not necessarily people's first choice."
House calls typically last about an hour, and the doctor ensures the employee receives the follow-up care he or she needs from a primary care physician. In addition, the house physician can refer the patient to other employer-sponsored health and wellness programs and help the patient select a PCP for follow-up. If the patient has a PCP, the house doctor will follow up with that physician.
Sheehy believes that the whole procedure ensures that the service has replaced a situation where someone would have otherwise gone to the emergency room.
Microsoft started a pilot program using Carena in April 2006, gradually phasing in the approach with its Puget Sound, Wash., population.
By January, the company had extended the program to all of its employees and their dependents, about 75,000 to 80,000 members.
Achieving savings and satisfaction
Carena conducted a survey on Microsoft's behalf, showing that 80% of members treated by Carena would have gone to the ER if the service were not available.
On average, a Carena physician visit costs about 20% less than an emergency room visit.
"When we compare the average cost of a house call to the average cost of an ER visit, we see considerable savings," Sheehy says.
Moreover, she explains, the nurse line representative may refer the individual to a Carena physician for a house call, resulting in the physician calling the member.
The phone call sometimes leads to a watch-and-wait or treat-at-home situation, eliminating the need for an actual house call.
"Just having the opportunity to speak to a doctor over the phone not only stopped the ER visits, but also the house call as well, thus ensuring additional savings."
Microsoft also sees the service as a multipronged effort to really help employees understand how best to utilize health care benefits. Many of company's employees in the Puget Sound area are from other parts of the United States or different countries altogether - resulting in many workers without a PCP in their new area, or workers encountering the U.S. health care system for the first time.
"The program can help with that," Sheehy says. "We have found that the education that Carena does on our behalf in those house call visits is 10 times more effective and is a real learning moment for the individual."
So far, the software giant has had a positive experience with the program-not only from the point of view of the cost savings, but also with employee satisfaction. Employees praise the program, citing Carena's convenience, the quality of care and the caliber of service provided the house physicians, Sheehy reports. "Some say it was the best medical encounter that they had."
Workers also like that the service saves the company money without being a cost-shifting measure to employees, she adds.They realize "it positively affects the bottom line, and we hear direct feedback that this is the type of program that keeps them working at Microsoft."
