Instrumented Interconnecteds Intelligent
August, 3rd 2009

Following is a guest blog post by Dr. Paul Grundy

While the national debate on health care reform heats up, we’re seeing an area of common ground: the need to focus on wellness, prevention and primary care. Studies show that when someone has a comprehensive primary care provider as their usual source of care, their medical care costs one-third less and they have a 19 percent lower mortality rate.

If we increase prevention and wellness programs, we’ll reduce expensive emergency room care and free up doctors to spend more time with patients to keep them healthy — not over-treat conditions, which ratchets up costs.

I touched on this in a recent segment on BBC-TV. We need more physicians to take the initiative on health care reform through patient-centered primary care and prevention.

Doctors who embrace patient-centered care are spending more valuable time with patients, adopting electronic medical records to improve efficiency, and even consulting with patients after-hours via email to gain a full view of the patient, 24/7.

The notion of comprehensive primary physician-based care that creates a “medical home” has been proven to reduce a patient’s medical bills because it veers away from expensive, unnecessary medical tests and procedures. That’s more crucial than ever: according to a study published online by the American Journal of Medicine, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs.

We must work with physicians to build a comprehensive system of primary care and align this with how we pay them. Let’s learn from the truly successful examples. IBM employees who are patients at Kaiser Permanente are experiencing one-third less deaths from heart disease. And when they go for their eye glasses, someone will ask them about an overdue glaucoma screening exam — not about an unrelated procedure that is of little or no value to the patient.

Other places like Geisinger in Pennsylvania and Healthpartners in Minnesota are doing exciting things with a focus on primary care. At Geisinger a patient centered medical home model decreased hospitalizations by 48%. Healthpartners has pioneered nonpayment for treatment of preventable complications and they have focused on condition management at the point of care delivery.

Fixing the health care crisis is a huge task. We clearly want to have care for all, but in order to afford this, we need to focus like a laser on transforming the model of care itself and building upon the need for primary care and prevention. We need to accomplish real care management — at the point of care delivery — with the tools and technology to support primary care. That should be accomplished not in a physician-centric way, but in a patient-centered way with a total team approach, involving nurses, mental health providers, pharmacists, office staff and physicians.

As a large employer, IBM has 450,000 reasons to care about the national discussion about healthcare reform — counting employees, retirees and dependents, IBM spent. $1.3 billion on health care alone in 2008.

And as a country, we need to invest more in primary care doctors and incent them in line with the outcomes we want: better health. Only on this foundation can we build smarter healthcare that makes sense.

Dr. Paul Grundy is Director, Healthcare Transformation, IBM, and President of the Patient-Centered Primary Care Cooperative (

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But we also need to focus on the overall cost of health care on the part of the medical industry itself. Preventative care is very important at this point, considering how out of control most Americans’ health has become, but medical costs need some control as well. Insurance premiums have increased about 125% in just 10 years, and it isn’t solely due to corporate greed. Medical costs for procedures and treatments have continued to climb in the past decade alone and there are many in the health care industry who are aware of it.
I found an article on the health care debate written by 23 medical professionals and doctors who stand on both sides of the health care debate, but many of their viewpoints tend to correspond.,com_sectionex/Itemid,200076/id,8/view,category/#catid107
The current model is based on treatment, but there needs to be focus on prevention. This is one factor, along with information and communication technologies, as well as procedural pricing.

Posted by: Maguire
August 27, 2009
9:53 pm

Bruce, I need some help too. 450,000 reasons. I am not sure how old his data, but most reports that I see have IBM with 398,000 employees. 71% of those live outside the US. I am not following how we spent $1.3B on healthcare when many of the countries that have high populations of IBM employees like in Europe have national healthcare systems. Tort reform to keep the multi-million dollar lawsuits and allowing insurance companies to sell cross state lines will lower cost. I recently moved, and the State where I live now only has one option as the insurance company.

Posted by: Earl
August 24, 2009
4:12 pm

Another area that I believe needs to be addressed is unnecessary tests and procedures driven by doctors’ fear of litigation. If a doctor has any hint at all that something might be wrong, and they don’t do something about it, they risk being sued. I think they also feel they are acting in the best interests of the patient by following up on absolutely everything, even if it’s only a million-to-one chance that there’s truly a problem. But I’ve gotten to the point where I am afraid to mention any minor symptom or discomfort to a doctor for fear of being sent for a barrage of tests. And going through pregnancy and childbirth in this environment is quite an experience – I felt I was constantly fighting with medical professionals to prevent them from intervening in a perfectly normal, healthy pregnancy.

Of course there must be some recourse in the case of true malpractice, so I am not advocating eliminating all litigation, but I think the medical community, and the courts, need to recognize that while death and disability are certainly negative outcomes, excessive interventions and unnecessary treatments and tests are also negative outcomes and we must find the balance between the two.

To give an example, if we decided c-sections should be performed on every pregnant woman as the standard method of birth, perhaps it might reduce the infant mortality rate by .01% (I’m making up a number for the sake of example, but I think it’s plausible that eliminating natural births would eliminate a very small number of unforeseen deaths and serious injuries that occur during the process of birth and would very, very slightly decrease the mortality rate.) Would it be worth it to perform major surgery on hundreds of thousands of people every year, either in terms of the outcome for the patients or monetarily?

I believe this issue is driving many of the increases in health care costs we’ve seen in recent years. People are simply getting more tests, more procedures, and more interventions, but are we any healthier for it?

Posted by: Deanna
August 21, 2009
12:08 pm

Bruce, you ask a good question. But I’m sure there are many variables as IBM has a cafeteria plan approach and choices vary from area to area. In my case we have Kaiser Permanente mentioned in Dr. Grundy’s remarks, and for a family of 4, (Self + Spouse + 2 Children our cost is $229 / month ($2748/Year) for Medical Only (does not include dental, vision or HCSA). We are very happy with our Kaiser coverage and the comprehensive care we receive with reasonable co-pays of $20 per doctor visit, $10 prescriptions, $250 hospitalization, $0 for labs. It is my great hope that these healthcare reform efforts move the country in similar directions as Kaiser rather than putting at risk our continued access to this level of care, at what I believe is a reasonable cost given the overall care we receive. As you ask, it would be very interesting to know the actual cost and IBM’s actual share vs. mine.

Posted by: John
August 18, 2009
12:20 pm

Can someone help me with the math? IBM spent $1.3B on 450K people, or approx. 3K / person. My contribution to the plan is approx. $1800/year so I’m covering a little over 50% of the avg. cost/ person. I’ve been under the impression that IBMers cover approx. 20% and the company covers 80%. If all 450k of us each put in $1800 that would be $810M of the $1.3B.

Posted by: Bruce
August 14, 2009
8:08 pm

Susan/Dennis. you both bring up good points.

Dennis, systems most certainly need to center around – and reward – wellness (i.e., “Stop eating crap, get off the couch, go for a walk). Does current legislation being debated have enough wellness / disease prevention built into it?

Posted by: Adam Christensen
August 14, 2009
6:12 pm

1) People have to take responsibility for their own lives!! Stop eating crap, get off the couch and go for a walk.
2) Health Insurance and Medical Litigation Reform.
3) Too many elective procedures are mandated by the gov’t to be covered by the insurance companies.

Health CARE is great.

Posted by: Dennis
August 14, 2009
10:49 am

To reduce costs, we need to reduce unnecessary tests. To do that we must address defensive medicine.

Posted by: Susan P. Sidway
August 13, 2009
1:50 pm

Does Prevention Reduce Costs?

“One of the common memes in the health debate is the claim that increased spending on preventative medical care (e.g., cancer screening) can reduce overall health spending.

That idea is very attractive, since it seems to offer a free lunch: greater health at lower cost. It has just one small problem, though: it isn’t true.”

Posted by: Chris Caron
August 6, 2009
5:54 am

People’s primary concern during these times are the greatest demand for health care. More and more people are seeking for short term installment loans in order to get through such medical emergencies. Doctors and short term installment loans are two things that Americans should not have to do without. Healthcare is crucial in order to keep people healthy. For those financial emergencies, small consumer loans should be an option. If what the latest Physicians’ Foundation survey says is true, then doctors will definitely be feeling the sting. The Physicians’ Foundation strives to promote the safety of patients and doctor education. Seventy-eight percent of doctors who responded to their survey believe that there are already too few family physicians. Almost half of those who responded are angry that the government and HMO regulations have ruptured their ability to care for their patients

Posted by: John Kaphal
August 5, 2009
8:10 pm

All of this is true! One interesting point is education. This country continues to push for 4.0 students even as nurses. However the typical book smart-regurgitate information type students aren’t always the best listeners or even empathetic. If we are going to change the health care system-lets change it all. The students with good people skills and hands on learners and desire to help people can equal a 4.0 student–it’s about a well-rounded health care professional.

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August 11, 2009
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[...] and Dan Pelino will be participating in the discussion. Readers of this blog know Paul has been a strong advocate for primary care reform. You can watch the video live [...]

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August 10, 2009
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[...] Paul Grundy will be participating in the discussion. Readers of this blog know Paul has been a strong advocate for primary care reform. You can watch the video live [...]

Posted by: Live video from the White House on Health Care with IBM’s Paul Grundy | A Smarter Planet
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