Keeping a lid on the cost of health care is a concern of most Kitsap residents. And according to an expert panel at the Kitsap Business Forum Aug. 11, the key to keeping costs low while still providing quality care will require a combination of preventative care, ceasing the use of tobacco products and encouraging people to visit their doctor regularly instead of going to very expensive emergency departments.

Panel members who met at the Kitsap Conference Center in Bremerton included David Schultz, market president for the CHI Franciscan Health peninsula region, Jim Page, with Group Health and KPS, Jay Burghart, CEO of The Doctors Clinic, Dr. Jenifer Kreidler-Moss, CEO for Peninsula Community Health Services, and George Berni, medical director for Harrison Health Partners.

Kreidler-Moss said PCHS has focused on delivering better health care at a lower cost and said the Affordable Care Act had a huge impact on her business.

“In 2012 our uninsured rate was 57 percent – not sustainable,” she said. But with the ACA, “our uninsured rate for last year was only 8 percent” because the ACA enabled a much larger group of people to obtain insurance.

“So when they go to the hospital, there’s coverage. There’s not as much charity care, there’s not as much write-off,” she said.

Kreidler-Moss said patient education about how to use the health care system wisely was still needed to prevent patients from going directly to expensive emergency departments in situations where it would be more appropriate to visit their regular doctor.

“The first month that the Affordable Care Act hit we had everybody and their brother in our extended hours – which is kind of like our urgent care – because they thought that’s how you get care.” PCHS now focuses on trying to show people the correct, efficient way to obtain care so that all the costs will eventually come down.

Page told audience members that they “probably should have gasped” with astonishment at the insurance figures that Kreidler-Moss mentioned.

“Whether you agree or disagree with healthcare reform, the numbers she gave are incredible. That one number alone at least in my opinion proves that the changes we’ve made the past couple of years are good changes. People now have access to care; it’s financed. Believe me, it’s expensive, but going from 57 percent down to 8 percent … is pretty fantastic,” Page said.

Page said Group Health adjusted its hours at its Silverdale urgent care center to encourage people to avoid going to the emergency department.

“In Kitsap County we do have an issue with people using the emergency room too much,” Page said.

Berni, who has been a doctor for three decades, said the “human connection” between patients and health care providers was key because if a patient feels welcome and comfortable with a provider, they will feel like they have someone they can call instead of going to the ER. Schultz said Harrison Medical Center has seen an impact of the Affordable Care Act, including at St. Anthony Hospital.

“St. Anthony’s emergency room visits have grown 22 percent over the last 15 months. Harrison’s have grown 10 percent. So as people have gained access to insurance coverage their first point of access, unfortunately, has – at least for this community – been the emergency department,” Schultz said.

To resolve the problem, employers could encourage employees to not use the ER except during emergencies. Employees could also take advantage of virtual online or phone-based care, or have wellness programs that encourage healthy eating.

“We get all of our [Harrison] employees registered with the Fitbit,” Schultz said, referring to a small electronic wristwatch-like device that could help users keep track of physical activity and health.

“We’ve reconstituted our cafeteria to make sure that high-sugar products are hard to reach … and it quite frankly has made a lot of our employees mad,” Schultz said. His comment elicited a chuckle from the audience.

As simple as it sounds those basic steps such as eating healthier and exercising can make a big impact on lowering costs.

Page said encouraging customers to stop smoking could lower the cost of health care.

“Smoking drives up the cost of health care and it also makes for less healthy populations. I know we all know that and yet it comes down to doing something about it,” Page said.

Berni, a thoracic surgeon, agreed with Page: “80 percent of what I operated on is related to cigarette smoking,” Berni said. “That’s a huge number. So quit smoking.”

Schultz said, “One of the things that CHI Franciscan are doing as a whole for all of south sound is trying to add 150 new primary care providers … in the next three years. 50 more per year for the entire south sound.”

Schultz also added that care providers needed incentives to focus on prevention.

“Whether it be Medicare, Medicaid [or] commercial payers … they need to pay us to keep patients out of the hospital. Right now that’s not the case. We still get paid more to treat patients than we do to keep them well. That’s an incentive that has to change,” Schultz said.

Other ways to lower the cost of healthcare was to be proactive when managing diseases like diabetes. Also, it was important for patients to follow instructions with their treatments so that they didn’t become ill again and thus require another trip to the hospital. By having a proactive follow-up program, providers could call patients to make sure they’re following those instructions.

Using generic drugs instead of name brand drugs can also reduce costs. Page said that pharmacy costs today accounted for a staggering 25 percent of total healthcare costs.

“30 years ago it was about 7 percent. Not necessarily a bad thing because theres a lot of magic pills out there,” he said.

Page said that ultimately it’s about personal choices.

“You have to have the wherewithal to encourage your employees to make healthy choices. You as individuals have to make healthy choices,” he said.

When asked what healthcare would be like in 10 years, Schultz replied, “at a minimum, I see increased incentive to not use acute care services” in the form of self-insured plans.

“In 10 years time we will start seeing the hospital becoming a place for the sickest of the sick and the outpatient infrastructure for healthcare services … will certainly grow and expand.

“Unfortunately I also see that you’re going to start seeing a two-tiered system: those who can pay for an extra level of care. Those that can pay to go wherever they want are going to do that. And those that perhaps cannot are going to be mandated to use their local provider, perhaps not get the same access points.”

Page thought that in 10 years there would be more consolidation and perhaps a single payer system in place.

Kreidler-Moss said in 10 years patients could see more diversity in the types of healthcare providers they saw.

“It is a crisis everywhere that family practice docs aren’t able to be churned out at a rate we need. The 250 docs that we need in the area is never going to happen,” Kreidler-Moss said.

“People have to get more comfortable of going to a pharmacist for management of some things. Going to a nurse independent of a doc for management of some things. And taking their own ownership, again, in their care and what that is to them. Some people are not going to stop smoking. I’m not going to stop having a quarter pounder on Saturday. It’s the reality that people are still people and they get to choose what they want to do.”

Burghart said there would be more standardization of best practices and less diversity in how care is rendered. A patient who was not self-managing their care well was a patient who was just too expensive.

“The things that we never even dreamed about happening outside the hospital are going to start happening outpatient,” Burghart said.

“That’s the way our system is going to be able to adapt to baby boom volumes that are coming.” Without such changes, there will not be enough resources to care for all the people on Medicare.

Berni said the biggest challenge is what is done in regard to end-of-life issues.

“We’re spending the majority of our healthcare dollar on the last year and a half [to] two years of life,” Berni said.

“We need to have a better standard or mechanism for providers to help our patients with that fear of dying; to help the families with the guilt of letting their parents pass away. Unless we do that, we’re going to continue to escalate those costs because we’re going to have an ever-increasing aging environment which our kids – our kids – are going to have to fund.”

(Note: edited 8/14 to fix misspelled name.)