The best way to contain the rising healthcare cost is preventive medicine. Many Preventive Care programs have been established but do these programs catch diseases early enough in order to intervene resulting in a positive outcome, and provide a positive patient experience in order to maintain patient compliant?
At the Lahey Clinic in Burlington, MA, they have established an Executive Health Program (the name is a little of a misnomer) that have achieved these goals. I interviewed Linda Moulton, Executive Director of the program to get an in-depth look into this program and why they have been successful.
1. Linda, What is the Executive Health Program and how it is different from any of the other program at Lahey or any other hospital?
It's a comprehensive preventive care program that is provided in one day with the results of all test the same day. The results are reviewed line by line with the physicians and a plan is developed for a follow on or a lifestyle management plan for the following year. The brochure outlines the individual exams and test that will be performed during the day. The physicians meets with the patient at the beginning of the day, they go around and a series of comprehensive tests are performed, the test results come back immediately and they spend an hour or more reviewing the results. Comprehensive preventive care is different from what you may have with a primary care.
The only other hospital that has something similar is Mass General and their program is quite different. It's not the same day review of test results. They only provide the person with an escort to get the various test done in a day, but it doesn't have the same patient experience in terms of a dedicated suite and high touch scheduling of appointments that day.
There are private programs that say they do "executive health" for example in an office building. The big difference is that they do some of the testing in the office, but follow up is the responsibility of the patient. We take it one step further. Since they are already in the hospital, if they need a follow up with a specialist, we will arrange it for them the same day.
The guideline of tests to be performed are laid out by us (Lahey) and are US guidelines, but depending on the situation, they can eliminate or add test to the guidelines. I would say the type and number of test are broader based.
Is the Executive Health Program similar to a "Concierge Health Program"?
Concierge program is different from an Executive Health Program. The Concierge Program focuses more on the patient experience. A person would sign up for the program and be provided with a phone number to call anytime of the day, seven days a week. If they have a problem they would get a physical that is more extensive than you would typical get from your primary care physician (PCP). But not as extensive as you would get for executive health. It is similar with the very high touch patient experience structure, but in terms of what is test are being offered it is different.
Are there any examples where your program has caught things that the other programs would not because your program is comprehensive for testing?
Yes, for example, a 59 yo male, drove up from the Cape for the program because he was sent by his employer. I said he didn't know why he was there because he felt fine. Very early in the exam, the physician discovered a very serious heart issue to the point they didn't want him to drive home.
Lahey: Asked him if he ever had shortness of breath?
Patient: Yes, but didn't think it was anything.
Lahey: Did you ever had numbness or pain in your arm?
Patient: Yes, figured it had to do with my work.
Lahey: Actually it a congenital heart defect.
Lahey: Did your father ever had any issues?
Patient: Yes, he died young of a heart attack. I go to MGH every year and I can't believe this never came up.
They (other institutions) aren't doing the type of testing that will give them awareness of this problem.
What we can do because of the way we are set up is immediately call the cardiologist and have this guy seen immediately. They made the phone call and got him in. Three days later he got surgery to correct the defect. So now he never has to worry about an emergent issue do to this problem.
Is the reason you got this problem is because you are doing more extensive testing or is it because you are taking the time with the patient?
Some of it is the individual test. we are always looking for approved test that are affordable and will take the program farther and be more meaningful for the patient. Some of it is the test and some of it is the time and care with each patients.
People who enroll in a concierge program tend to have 24/7 access to a clinical person and if you come in for a physical exam, it probably takes an hour. For the patient, it just knowing that they have access to a clinical person should they have any issues or questions.
3. Is this program covered by most insurance plans?
This is not covered by domestic insurance. Outside of US, it is not unusual to have coverage by insurance. In the US, employers are choosing to pay cash for services or individuals will pay out of pocket. It's short sighted by the insurance companies.
4. Why have you/Lahey decided to have this program focus specifically on executives both here and abroad? Can you define what levels are included in the term executive?
Executive is just the name of the program. We are not defining it as executive. It's up the employer how broad of a base they want to cover. It's not just for C-suite employees. We are not limiting access.
From a company perspective, when the focus is on employee wellness, this is a differentiating factor for an employer to ensure care and attract good talent. For a busy employee, employers can be assured that the employee is getting quality care, since everything is done in one day, but it's only taking the employee out of the work for one day as oppose to making many appointments on different days.
5. What has been the reception of this program from your target customer (companies, dignitaries etc.)?
Ninety eight percent patient satisfaction and 98% come back. About 70% of companies are domestic and 30% international companies. We have companies from 65 countries.
When I first came to the Lahey, word of mouth was the only way to get word out. But now that I am here, we are more strategic in getting the word out. I'm focus on broader coverage in getting the word out through Boston Magazine, Top Doc magazine etc. Almost no one says no, they are always interested. If they say no, it may be due to geographical challenging for the company to fly everyone to Lahey.
6. Coordinating care with executives around the world can be difficult with respect to language, culture, and business barriers, how have you been able to successfully overcome these barriers?
I don't think we have any issues with it. We communicate primarily by email. We're operating in a global environment. Culture is not a barrier because they are choosing to come here. We have interpreters for language translation if that is required. We have patients that flew in from a small African nation. Two of the three people just came in for a physical and then went home. A long way just to have a physical. But they trust Lahey and we established a relationship here. The only potential barrier is language and we have interpreters.
7. Are there any statistics demonstrating that this level of care has improved the longevity or quality of life for these executives? particularly for future insurance coverage.
We are not gathering data to get insurance coverage because that is not our role. But in terms of quality of life and longevity we have all the information. We are catching things early and intervening early, which addresses the idea of quality of life and longevity.
8. Can this program be adapted for the general population? With Obamacare and accountable care organization (ACO), will Lahey take part in establishing an ACO program or do they already have a program in place?
Lahey is active in ACO programs but this is outside of my program so I can't speak to it. Winchester, a sister hospital and an ACO is running very successful.
We actually have an executive care program in Gordon and we expanded some aspects of the program to the US. The focus is to make the program more accessible to everyone.
9. Why did you decide to head this program?
When I arrived, I was focused on the international program, but the fact that 30% of the Executive Health program are international companies, seem very important that I have some involvement in this program as well. Both programs are high patient experience and high touch program, so it made sense to have both programs report to me. I'm very glad because the program is hugely valuable in the type of care offered.
10. What do you find the most rewarding?
Hearing that the patients really like the program and have a great experience going through the program.
11. Is there anything you would like to add or improve on the program?
We are always looking at tests that get approved to see if they are appropriate in terms of offerings. I am looking to expand the physical space because being able to spread out will enhance the patient experience. Have a phenomenal team there, in creating a real relationship.
For any questions regarding this program, you can contact Linda Moulton at Linda.A.Moulton@lahey.org or at 781-744-3464.