The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and How Every Company Can Do the Same Review

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The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and How Every Company Can Do the Same ReviewRecent Washington health care reforms have done little to reduce costs - our #1 problem in health care. Instead, the focus was on improving access. John Torinus, chairman of Wisconsin-based Serigraph, took the problem of employee health-insurance cost doubling every eight years into his own hands. (Serigraph is a 61-year-old firm with 450 U.S. employees, 1,700 world-wide, focusing on plastics printing via pressure-sensitive decals, in-mold decorations, and silk-screening.) At the time ('03), health costs were the firm's third-largest expense and headed towards second-largest. Over the last seven years their increases (employer and employee) ave averaged 2.8%/year, vs. a national average of 7% - without cutting benefits. Changes emphasized consumer responsibility, centers of excellence, and a prime role for primary care. Previous efforts (wellness programs, some rationing, participating in a buying group, and cost-shifting to employees) had accomplished little. The firm is now self-insured, saving over $1.5 million/year (about one-third of average expenditures), with costs now split 80/20 with its employees.

In the new plan, employee premiums dropped by about $1,500 to almost nothing, in return for $780/employee in a form similar to Health Savings Accounts, higher deductibles of $750, $1,000, or $1,500 (employee's choice; formerly $300), and 30% in network co-insurance (same as before). Maximum employee out-of-pocket expenditure/year is $3,250 to $6,000. Other current benefits include free on-site annual mini-physicals (including blood work), rebates of $250 (upper GI endoscopy) to $2,000 (CABG) for use of 'Centers of Value' for specified electives, $5 generic medicine co-pays, access to a free on-site clinic staffed by a nurse practitioner, nurse, chiropractor, and dietitian), free primary care through an on-site part-time primary-care doctor, an on-site fitness center, free elective procedures via a medical tourism program (eg. $5,000 for a knee replacement at Apollo Hospital in India, plus $5,000 for travel with a companion - vs. $$36,000 locally; CABGs in the U.S. average $80,000, vs. $25,000 in Costa Rica, $8,500 in India, and $34,000 at better U.S. facilities), free second-opinions on electives, and free prevention exams (mammograms, Pap tests, colonoscopies, prostate tests). Serigraph's web-site provides employees with bundled price and quality ratings for 27 electives (information accuracy verified by the local BC/BS). Employees wanting expensive brand name drugs instead of effective generics or substitutes pay the cost difference, plus $30; expensive drugs lacking cheaper equivalents are paid for by the firm, less the $30 co-pay.

Serigraph employees also get half the savings from any billing errors they discover. Outpatient bills sometimes have half their costs accounted for by 'non-specific outpatient treatments" - impossible to decipher without lots of help, from the hospitals. Hospitals also hire consultants and staff to 'up-code' to more expensive charges, obfuscate price increases by limiting the largest increases to the least-used services and then publishing the unweighted average increase, and resisting bundled (simpler, encourages higher quality) pricing. (Bundled pricing actually was initiated by a hospital in 1984 - the Texas Heart Institute; Geisinger Health System since added rehospitalizations within 90 days to their bundled pricing.) Still another hospital network strategy is buying up primary-care practices to incentivize them for keeping within their high-priced system. Insurers, for their part, get around state limits on rate increases by reclassifying a firm's level from 'preferred' to 'standard' or 'sub-standard.'

Serigraph employees now shop for care to reduce their co-pays and share of overall costs, avoid non-emergency ambulance trips (Torinus is justifiably angered by the reputed common practice among Medicaid recipients of calling an ambulance to go to an E.R. for a sore throat), and are more likely to adhere to provider care plans (they're rewarded with time off for following recommendations, as well as good test results).

Torinus asserts, along with many physicians, that there is no relationship between health care costs and quality, whether measured by patient outcomes or adherence to treatment regimens recommended by expert panels. (Providers with greater experience and acquired skill take less time, make fewer errors - potential lives saved/year estimated at 3,000; surgeons using checklists reduce complications by 1/3 and in-hospital deaths by 20-50%. Staffing ICUs with specially trained intensivists would save nearly 50,000 lives/year and $4.3 billion. Sources: Leapfrog Group, Dr. John Birkmeyer.) Overall, Torinus also believes too many companies delegate health care to H.R., don't give the topic the 'C-level' attention required, and limit efforts to simply undertaking routine bidding - trusting the health plans to do the work. (Torinus' explanation of why the latter doesn't work was unclear.) He's also a supporter of electronic medical records because they provide care reminders, help prevent drug interactions, provide automatic summary of patient test results for improved provider assessment, and avoid duplication of tests, etc. Direct-care firms such as ModernMed (provides physicians and e-records; physicians sometimes make house calls), Aurora Health Care (co-manages Serigraphs' diabetics), and BridgeHealth International (a resource that arranges world-class quality for major elective treatments at low-costs via 'medical tourism') also receive Torinus' endorsement.

Author Torinus does not claim to be the only business-leader taking such actions, citing several other firms with a brief reference to their actions. On the other hand, he's much less impressed by government managers - reporting that their health care costs are worse, in general, than private firms. The national overall average in 2009 was $8,659 per employee, vs. Serigraph's $6,648. Serigraph's family plan cost is almost $5,000 below the national average. Employee health status measures have also improved - eg. blood pressure, cholesterol levels, body-mass indices.

Bottom-Line: My initial reaction to Torinus' title ("The Company that SOLVED Health Care") was rather scornful - America's health care system problems are so extensive that they are incapable of being solved by any company or group of companies. Further, business leaders previously have claimed significant reductions in health care costs; closer examination, however, has shown that most of what they've accomplished is simply cost-shifting to employees (reduced benefits, higher co-pays and deductibles), temporary savings from switching providers, or claiming meaningless provider 'discounts' that are normally already incorporated in their insurance premiums. Fortunately, Torinus is the 'real thing;' his book, despite an overenthusiastic title, provides useful information on what to do, and how to get started without waiting for the government. He deserves our gratitude for his diligence, ingenuity, and willingness to try new approaches.The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and How Every Company Can Do the Same Overview

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