Advocates for the ailing | A Gray firm helps employers and their workers navigate the health care system
Photo/Tim Greenway
Bill Williams, CFO of The Baker Co. in Sanford
Photo/Tim Greenway
Bill Williams, CFO of The Baker Co. in Sanford
Photo/Tim Greenway
Jim Ward, president of Patient Advocates in Gray, helps about 30 businesses in Maine and elsewhere design health care plans tailored to their employees' needs
Photo/Tim Greenway
Jim Ward, president of Patient Advocates in Gray, helps about 30 businesses in Maine and elsewhere design health care plans tailored to their employees' needs
Earlier this year, a 30-year employee of The Baker Co. in Sanford was rushed to a local hospital with difficulty breathing. Three days later, the man's frustration intensified as doctors failed to determine a diagnosis. So a nurse provided through the man's health plan at the biotech company arranged for him to be transferred by ambulance to Massachusetts General Hospital in Boston, a center for health care excellence. Doctors there immediately determined he needed a double lung transplant, and the nurse traveled to Boston to shepherd the man and his family through the daunting procedures and arrangements that followed.
âThe patient and the spouse and the whole family were very happy because of the care they were getting, their questions were getting answered,â says Bill Williams, Baker's CFO. The nurse was dispatched to assist the man on behalf of Patient Advocates, a firm in Gray that helps individuals and businesses navigate the health care system. Baker has been a client since 1992, when it turned to Patient Advocates in the face of spiking insurance costs. After factoring in the fees it pays to the firm, Williams estimates Baker saves 10% annually on health care costs. âThey're getting good care and they're getting immediate access to the care,â he says of the company's 145 employees. âThat saves me money.â
Patient advocacy has emerged as a growing field, as those seeking health care wrestle with an often fractured delivery system, complicated insurance plans and denied claims. The advocates serve as an intermediary between patients and their medical providers and insurance companies, lending expertise and guidance. The industry isn't regulated, so precise figures are hard to pin down, but the Patient Advocate Foundation, a Virginia nonprofit recognized as a leader in the field, reports a nearly 19% increase in patient call volume so far in 2010 over the same period last year. The foundation received more than four million contacts from patients, family members and health care professionals in 2009, seeking its free assistance on questions ranging from medical debt crises to insurance benefits to how to enroll in government programs.
The Baker Co. took interest in the field almost 30 years ago, as costs for its Anthem Blue Cross Blue Shield plan climbed steadily higher. Working with Patient Advocates, Baker took the leap to become self-insured, offering employees unrestricted access to a nursing hotline and 100% coverage of preventive procedures such as colonoscopies, among other benefits. âThey've helped us tailor our plan to our employees' needs,â Williams says.
Seeing a need
Jim Ward, president of Patient Advocates, recalls an episode many years ago that starkly illustrated to him the pervasive inefficiencies of the country's health care system. Then working in the employee benefits division of an international consulting firm, Ward came across the case of a more than 70-year-old woman who had been injured in an auto accident. Her medical records indicated that the elderly woman's doctor had given her, of all things, a pregnancy test. âThere was a clue there,â Ward says, chuckling.
Ward went on to help develop Maine's first PPO, and then in 1995 to found Patient Advocates, seeing the potential cost savings in higher-quality health care. Today his firm serves about 30 clients, many of them private businesses with work forces ranging from 7,300 employees to 25. He and his 28 employees, including eight full-time nurses, help companies to design plans that best fit their workers' needs. But they also help them to realize that while health care inefficiencies are inevitable, doctors and hospitals - he refers to them as âvendorsâ - don't necessarily have the last word. âIf you went into a business and you had to wait for two hours for someone to see you, and that was considered OK, you wouldn't stand for it,â he says.
Many of Ward's clients are self-insured, and use Patient Advocates to handle their claims. Other companies covered through the insurance market seek out the firm's help in handling denied claims, seeking second opinions and other efforts. The firm's nurses offer on-site health screenings, telephone help for patients suffering anything from colds to diabetes, and also remind patients to follow up with preventive care, such as mammograms. âOur nurses don't approach talking with a patient on the basis of money,â Ward says. âThey talk with patients on the basis of getting you the care you need.â
That doesn't mean money isn't being saved, however. Clients reap the greatest savings on inpatient hospitalizations, often as a result of sending patients to Boston, Ward says. âIt's world-class care, we can get them in faster and the price differential ranges from 20% to 50% lower,â thanks to fiercer competition, he says. The most common advice he offers to employers: âStructure your benefit plan to provide incentives for people to get consultation and treatment in the Boston area.â
Patient Advocates enthusiastically pursues beyond-the-border treatment for its patients, even outside the United States. Last April, the firm's head of customer service traveled to Costa Rica at the request of a hospital consortium there, and found American-trained physicians, many with Ivy League affiliations, offering quality joint replacement surgery in spotless hospitals, Ward says. The price differentials were staggering - a hip or knee replacement procedure that Maine providers charge $35,000 for costs about $12,000 in Costa Rica, he says. Ward's now working to send a Maine patient to the Central American country for treatment, with the employer planning to cover the costs of the flight and two weeks of recuperation.
Anxiety over health care reform has also led more people to consider offshore medicine, Ward says. âYou put 30 to 35 million new people in the system, there's going to be long lines for care,â he says.
Paying off
Patient Advocates, which is planning growth into New Hampshire, works with the Roman Catholic Diocese on its health plan for secular employees. With 400 to 500 people scattered throughout the state, communicating its wellness objectives proves challenging, Ward says. But the nonprofit's claims have plummeted, and employees who attend three wellness screenings a year wind up with a check for $750, he says.
At about $100 an hour, Patient Advocates' rates are among the lowest in the market, Ward says. The cost has been well worth it to The Baker Co., according to CFO Williams. The company, which manufactures biological safety cabinets (often for use in labs that handle infectious or other dangerous materials), just raised its premiums for the first time since 2005, and by less than 5%, he says.
With an aging work force - the average tenure is 18 years, while the average age is 47 - many of Baker's employees are greeting age-related health problems. Self-insuring and working with Patient Advocates to head off unnecessary or needlessly expensive procedures and preventing chronic disease has clearly cut health care expenses, Williams says. âFor the benefits [our employees] are receiving, our costs are lower than what they would be in the marketplace,â he says. One nurse left her cell phone number with an employee while she was on vacation, with instructions to call anytime, he adds.
But even smaller companies with younger work forces can realize benefits, according to Ward. He helped a landscaping company that employs mostly fit, able-bodied men in their 20s to save more than $200,000 in avoided premiums, he says.
Businesses willing to invest time and energy into managing their health care-related risks and that advocate for their employees - Baker has never laid off a worker, after three generations in business - can enjoy the greatest rewards, Ward says. He's guided by a motto: âThe least expensive care you're ever going to purchase is quality care.â
Jackie Farwell, Mainebiz senior writer, can be reached at jfarwell@mainebiz.biz.
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