The future of healthcare is centered around primary care providers, focusing on wellness as opposed to just treating illness and giving consumers information to make better decisions.

Those were the overriding themes of the 2012 Health Care Summit presented by Cincy and the West Chester Liberty Chamber Alliance. More than 300 people attended the third annual event sponsored by Humana, Horan, The Dry Cleaning Shop and ITA Audio Visual Solutions at the Sharonville Convention Center.

For more than an hour they heard different perspectives and questions addressed by the panelists: Doug Watts, vice president and CFO of The Metalworking Group, a small employer dealing with rising health insurance costs; Dr. Barbara Tobias, a family physician and Medical Director of the Health Collaborative which is leading physician practice initiatives, and Dr. Kevin Joseph, president and CEO of West Chester Hospital.

Dr. Derek van Amerongen, vice president and Chief Medical Officer for insurer Humana of Ohio, moderated the discussion.

Central to healthcare reform is what's been defined as the Triple Aim: improving the health care experience, improving the health of patients and reducing the per capita cost of healthcare.

Achieving those three goals won't be easy.

"Our challenge for 2013 is how to get our employees to live a healthier lifestyle," said The Metalworking Group's Watts.

He said his company learned the importance of employee wellness the hard way in 2011 when it switched to self-funding from buying insurance to hold down costs.

"It was an eye-opening experience," he said. "It cost more than we anticipated and led us to make a closer examination of our employees' health. In the self-funded world the claims come through to us each month. It became clear that the way to improve healthcare was to improve our employees' health."

Primary Care Vital

Drs. Tobias and Joseph agreed that increased primary care is vital.

"The best message employers can send to their employees is have a usual source of care with a primary care physician," said Dr. Tobias. "That's the key to better health, better quality and lower cost."

Incentives aimed at both providers and patients to encourage good health are important, Dr. Joseph said.

"Preventative medicine is much cheaper than treating an illness," he said.

The Metalworking Group used incentives to increase participation in a fasting blood draw of its employees.

"The good thing from a fasting blood draw is you can get a ton of data on your employees and they can learn a lot about themselves," said Watts. The trick was getting increased employee participation.

"We expected to get 50-60 percent of population. To me that wasn't good enough," he continued. So, the company raffled off a 60-inch Sony TV to increase employee participation.

"We got 90 percent of our employees to participate," he said. "And we found two undiagnosed diabetics among our employees. One gentleman was incredibly thankful because it allowed him to begin treatment." Realigning incentives is at the core of federal and local health care reform, according to Dr. Tobias.

"We have a long-standing fee for service system that pays for procedures and face-to-face care. We know to really deliver good health; we need to have physician access in between visits. The current fee for service model doesn't support population health," she said.

"For instance, your veterinarian sends you a postcard when it's time for your dog's heartworm medication. Your dentist also sends you post cards when it's time for your annual checkup. Primary care never did that because there's no reimbursement for reaching out to patients beyond when they come in to the office for episodic sick care."

With new health information technology, she said, physicians can reach out "to patients between office visits, responding to email questions. Sometimes saving thousands of dollars by responding to a question that historically would have taken three weeks for the patient to come into the office and ask."

In the Cincinnati-Dayton area, she said, 75 primary care practices have been picked to test this approach in a groundbreaking federal Comprehensive Primary Care Initiative.

The practices will hire coordinators to make sure they're reaching out to their patients "so you can make sure you're taking care of the sickest patients, keeping them out of the hospital and making sure they have the things they need to be healthy," Dr. Tobias said.

Dr. van Amerongen asked if changing the fee for service model is a threat to organizations like West Chester Hospital.

Dr. Joseph responded that if hospitals and physicians focus on patients it wouldn't be a threat.

"If we focus on the patient, ultimately everything else will fall into place," he said.

The introduction of state health exchanges in 2014 with the federal Affordable Care Act is expected to mean additional 30 million people will have health insurance and Dr. van Amerongen asked if the health care system was ready for that increase in numbers.

"The short answer is no, we don't have a primary care workforce in place if those individuals seek care," said Dr. Tobias. "But the long answer is we can be ready with our new delivery models0 and with team-based care we can start to be more responsive and effective."

Watts said his company uses its health insurance to attract good employees. "We feel with our pool of workers we'll have people who will qualify for subsidies on the exchanges and we'll lose employees to the exchanges," he said. That could reduce the options for the employees who remain in the company plan.

"There's a lot of uncertainty as we head into 2014 as to how this is going to affect us," he said. 

Meet the Experts:
Douglas J. Watts has been vice president of finance and CFO of the Metalworking Group in Colerain Township since 2000.

The Metalworking Group has been recognized with a Manny Award twice in the past five years for New Job Creation and was recognized most recently by the Goering Center as a finalist for the 2012 Tri-State Family and Private Business Award.

Watts holds a bachelor's degree in accounting and finance from Miami University at Oxford.

He began his career in manufacturing in 1991 as an accountant for Richards Industries in Cincinnati.

His philanthropic efforts include volunteer stints as treasurer for two Congressional races and one City Council race. He is currently treasurer for the Hyde Park Center for Older Adults and is a volunteer soccer and basketball coach. Doug Watts lives with his wife Michele and two sons in Hyde Park.

Dr. Kevin Joseph is president and CEO of West Chester Hospital in West Chester.

During his tenure as the medical director of the West Chester Emergency Department, he created a culture of patient satisfaction and quality, resulting in an overall patient satisfaction score in the 98th percentile.

In addition to his leadership role at West Chester Hospital, Dr. Joseph is a senior vice-president of UC Health. He has been recognized by the Becker's Hospital Review and Who's Who' in Cincinnati healthcare.

He obtained three bachelor degrees in Biomedical Engineering, Materials Science and Psychology from the Johns Hopkins University. He later graduated from the Vanderbilt School of Medicine.

Dr. Joseph also is the Medical Director of the Cincinnati Police SWAT Team and the Medical Director of the Crosby Township Emergency Medical Service.

Dr. Barbara B. Tobias is a family physician and Medical Director of the Health Collaborative in Cincinnati.

The Collaborative provides leadership and support to physicians and practices in public reporting, quality improvement and practice transformation initiatives including the Robert Wood Johnson Foundation's Aligning Forces for Quality and the Innovation Center's Comprehensive Primary Care Initiative.

She is the clinical advisor to the Greater Cincinnati Health Council and the Accountable Care Transformation Committee.

She is also the Robert and Myfanwy Smith Endowed Professor of Family Medicine in the Department of Family and Community Medicine at the University of Cincinnati College of Medicine.

Dr. Tobias was a 2009-2010 RWJF Health Policy Fellow in the Immediate Office of the Secretary at the US Department of Health and Human Services. She holds a bachelor's degree from Cornell University and received her medical degree from the University of Cincinnati.

Dr. Derek van Amerongen is Vice President and Chief Medical Officer for Humana of Ohio. In this role, he oversees the medical management and strategy for one of the nation's most innovative health plans.

Dr. van Amerongen has written and presented extensively on managed care and health topics.

He is on the faculty of Xavier University's School of Health Administration.