Monday, October 26, 2015

A Young Physician Calls Out A New Cause of Health Care Disparity

Since the formation of GBMC 50 years ago, we have always valued graduate medical education.  I have spent most of my career in academic medicine and teaching pediatric residents and medical students in pediatrics.  The act of being a teacher keeps you on your toes because the learners ask you questions and you realize that you don’t know everything and you have to seek out the information.   So, graduate medical education has always been a gift to GBMC and having smart, young, people—the next generation of physicians - around can only help us get to our vision faster.

Recently, I was glad to attend our Institutional Graduate Medical Education Committee meeting. The Chair of the IGME, Brian A. Kaplan, MD, FACS, who is also chairman of The Department of Otolaryngology and Head & Neck Surgery at GBMC is leading the group and helping us reflect on and continually improve our training programs.  During the meeting, we discussed many issues and one of our residents raised the issue about how we can better serve “underserved” populations and remove disparities in care.  Immediately, I started to think about disparities across racial and ethnic groups. We need to work to reduce these disparities but the resident added a new reason for some people not being able to get care - high deductible health insurance plans.  These are the type of plans where someone may have to pay $2-$3,000.00 out of pocket before the insurance kicks in. Our resident physician colleague was talking about how this was precluding some of her patients from getting the care that they needed.

Why do these high deductible plans exist? Well, one reason is that many people believe that you have to make patients “feel the pain” of high cost to get them to shop for better prices and therefore make producers work to lower their prices. When we shop for a car, we always look for the best price for the type of car that we are looking for. I am sure that letting patients know what the price is does have some affect. But I also know that in Germany, for the most part there are no co-pays or deductibles and their costs are about 40% lower than ours. I also believe that it is very hard for an individual patient to know what they are actually buying. Most patients don’t have enough knowledge to know what they really need let alone judge the quality from one provider to another. There is no JD Powers for medical care (Although hospital compare is a good start: ).  I believe that it is sad that we feel compelled to put the onus for lowering the cost of care on the patient. That is why I am so proud of GBMC HealthCare and our third aim …to provide care with the Least Waste. We have the knowledge and the ability to change our care delivery system to get the waste out so the patient is not stuck trying to do this for herself. Our patient centered medical homes, where teams led by physicians with nurse care managers and care coordinators have reduced the cost of care to Medicare beneficiaries by more than 10% over the last 3 years!

I am grateful to my colleague resident physician for being concerned about her patients being able to get the care they need. I am very grateful to all of our residents and faculty for helping us build a better delivery system and for their excellence in learning and teaching. We still have work to do in removing care that doesn’t add to health and in becoming more efficient at what does add to health so that fewer employers will need to have high deductible plans for their employees.

Case Management Week 
Recently, we celebrated all GBMC case managers during National Case Management Week. We are very grateful for all that they do to help our patients.

Case and care managers provide clinical assessment, care coordination, patient education, counseling, case monitoring/clinical pathway management, discharge planning, resource management and patient advocacy.  They are recognized experts and vital participants of the collaborative team, who engage and empower people to understand and access quality, efficient healthcare, as well as enabling cost-effective outcomes.

Our Case managers deliver dedicated assistance to our patients, their care teams and GBMC day in, day out.  Please join me in thanking our case managers for their hard work and for their important role in caring for our patients.


  1. Congratulations to all of the Case Managers here at GBMC! Thanks for doing such incredible work and for assisting patients and their families navigate the healthcare system!

    1. Thanks Stephanie. I agree. They do great work for our patients.

  2. Ironic, isn't it? You championed Obamacare, and people are not able to afford the high premiums and deductibles. This doctor and articles from Vox to WSJ have proven us critics that ACA would not lower costs to be completely correct.

    1. Thanks, Anonymous. Many local employers have moved to high deductible plans for their employees which as you know is not a result of the Affordable Care Act. Thanks for mentioning the ACA, though because before this law, patients with no insurance would not be paying only the deductible...they would be paying all of the bill. Now they may have a high deductible but their out of pocket expenses are fixed. The ACA is imperfect but it has helped many people.


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