Some say creating wellness requires making preventive and primary-care services more accessible. Nationally, Americans use preventive services at about half the recommended rate, according to the Centers for Disease Control and Prevention (CDC). But usage rates of preventative care increase when deductibles, co-insurance, or co-payments are removed.
Dr. Kathryn Gibson’s ankle is in a gray boot, fractured while she was running her usual 4-mile commute to work. In a time when medical burnout is high, such an injury could be one more discouraging development for a busy clinic director and practitioner.
In a 2014 survey co-conducted by the American Medical Association, 54.4 percent of physicians reported at least one sign of burnout—insurance companies pressuring them to bill for service, not “chitchat” or human interaction, is a significant contributing factor.
Gibson nods at her injury and utters a basic truth: “All of us need healthcare at some point.” As the director of a full-service employee health clinic at ARUP Laboratories with an eligible patient base of 9,300, Gibson knows all about the factors that can cause medical dissatisfaction. “We are trying to address the issue of creating better wellness in our country,” she says.
Doing that requires making preventive and primary-care services more accessible. Nationally, Americans use preventive services at about half the recommended rate, according to the Centers for Disease Control and Prevention (CDC). That said, usage rates of preventative care increase when deductibles, co-insurance, or co-payments are removed.
Increasing accessibility allows physicians to understand their patients better, states Gibson, who became interested in family medicine while talking with heart attack victims during her graduate studies. “After a heart attack, you can’t just say, ‘Here are your medications. We’ll see you in two weeks for your follow-up.’ Patients and their families are in shock. They need structured care that acknowledges who they are and what they value about their health.”
Kathryn Gibson, MD
“This clinic has allowed me to work in an environment where we can prioritize prevention, primary care, and patient relationships. Unless you look at the entirety of the person, it’s hard to affect their healing.”
Medical Director, Clinic
With that in mind, the practitioners at the no-cost ARUP Family Health Clinic, serving employees and their dependents, try to get to know patients and their lives. Services include not only check-ups, physicals, sick visits, therapy, and vaccinations, but also several life-focus initiatives.
The clinic is in its fifth year of a diabetes program. If a patient tests as pre-diabetic, he or she has the option of being served by a multi-member team that typically includes a wellness team member (a physical trainer or healthcare professional who is skilled in behavior-change coaching); clinic provider; pharmacist; care coordinator who helps guide patients through interactions with outside health providers; and nurse.
Fully diabetic patients are kept within the loop and provided with services. Team members reach out to patients by phone or email, sometimes as frequently as weekly or biweekly. In-person meetings with the team take place every three months. Support is given so patients can meet goals, such as cooking more healthfully or learning to use an insulin pump.
All diabetes medications are provided at no cost, which results in considerable savings for patients. According to STAT News, in 2013 the average patient paid more than $700 for a year’s supply of insulin and approximately $2 for each glucose test strip (used three to four times each day).
The clinic offers free allergy shots, saving patients time (no need to drive offsite to receive the shot) and money (cost of the shot plus approximately $100 per doctor’s visit).
Beginning in January 2017, patients with hypertension have been able to check their blood pressure at home using loaner test cuffs. Results are picked up electronically and reported through the private online patient portal, MyChart. Patients then receive an electronic copy of the data.
While insurance now dictates pay-per-service in most hospitals and clinics, Gibson points out that triage nurses and other practitioners at the ARUP clinic can work with patients by email or phone on certain issues, saving the time of an in-person office visit. If someone calls with chest pain, a nurse can question the person to determine whether the cause is acid reflux, anxiety, an asthma attack, a heart condition, or another factor. “Each possibility goes in a different direction; the triage nurse can help figure that out,” says Gibson. If a patient injures her ankle like Gibson did, the nurse can help them decide on the next step (pun fully intended).
Working in a primary care clinic outside the insurance circuit has helped Gibson focus on what’s important. “This clinic has allowed me to work in an environment where we can prioritize prevention, primary care, and patient relationships. Unless you look at the entirety of the person, it’s hard to affect their healing.”
Catherine Arnold, Science Communications Writer