Dr. Dean Gruner recently retired as president and CEO of ThedaCare, the largest employer in Northeast Wisconsin. As a family physician for almost 40 years, he says the highlight of his career was delivering babies. Gruner also led Touchpoint Health Plan for 17 years. He sat down with Insight Executive Editor Margaret LeBrun to talk about the current and future status of health care.
We’ve been accomplishing our mission at ThedaCare, which is to improve the health of the community where we serve, so to be able to leave at this point in time is really joyful. The bittersweet part will come when I start to think about the people I won’t get to see all the time.
What’s always been on my mind is, “How do we keep people healthy?” As a family practice physician, that’s how I was trained. We’ve had the best primary care performance in the Wisconsin Collaborative for Healthcare Quality. We’ve got 95 on-site clinics for employers. We’ve done a lot of community health improvement work with CHAT, our Community Health Action Team, which brings people together to study important issues. It has resulted in community ownership of problems — for example, Voices of Men on domestic violence, the Weight of the Fox Valley on obesity, what it’s like to be black in the Fox Cities, and now we are looking at end-of-life issues.
When you bring people together to work on community problems, then you’re actually doing preventive medicine. You are creating a healthier, more loving community — which is good for business.
I’ve got two thoughts on the Affordable Care Act. The logical part of me would say that there have been a lot of benefits from the ACA and a lot of people don’t want to see the baby thrown out with the bathwater. But there are some parts of it that have not worked as designed, so a reasonable approach would be to keep the good stuff, identify what needs to be improved and make adjustments.
From a ThedaCare perspective, we are focused on getting better at the fundamentals. How do we improve safety and quality and patient access while reducing the hassle of health care, control the cost and create a joyful environment for all our employees and physicians?
In health care what’s happened is a lot of people who were healthy did not sign up for health insurance on the exchanges, so what that has meant is insurance companies have been losing money.
A solution would be to find a way to have all the healthy people part of a risk pool, because that’s what insurance is. But people have this resistance to the idea of saying that people have to have health insurance. Somehow, for some people, that’s un-American. I don’t understand that. Maybe somebody can explain that to me someday.
Employers are asking employees to contribute more. The real issue, though, is how do you make health care more affordable? One way would be for providers to be held more accountable for the total cost of care and the quality they provide. Many insurers have not been interested in transferring that responsibility to health care providers.
But this is my teaser now: ThedaCare will have an announcement in the next month of something that we believe will put us in the position to do a much better job at aligning those incentives and helping us focus on keeping people healthy. We have been working on this for the past two years. It would be a relationship with a nonprofit insurance company, an existing organization that is not in this area yet. It has basically the same mission as us: to improve the health of the communities we serve.
Today, when we do great work to keep people healthy and reduce costs, the beneficiary of that is the large insurance companies. We don’t get paid extra, we get paid less, because people don’t need as much health care. I think we’re going to have a mechanism that we can do the right thing and get rewarded for it.
What we are going to announce will put us in a position to actually deliver on that. It gives me a great deal of hope. So stay tuned!