Management & Leadership

The Return of the House Call


With health-care reform dominating Washington, policy analysts and benefits experts are looking at every possible cranny to unearth new, futuristic ways to slash costs. Yet one innovation that has captured their imaginations actually comes from the dusty, predigital past. The Obama Administration has been keeping a close eye on Microsoft (MSFT), which, in a bid to slash costs, improve employee health, and even contain potential pandemics such as swine flu, has brought back the old-fashioned doctor's house call for employees. House calls appear in the proposed health-care reform package pending before Congress, and President Barack Obama himself has hailed them as one of the private sector's "terrific innovations."

Microsoft is one of the only, and by far the biggest, employers that is offering such white-glove, concierge-like service to workers. "The program," says CEO Steve Ballmer, "is an example of the importance the company has always put on its people." The Microsoft template doesn't make sense for every company. But for those with big concentrations of employees in densely packed locales—think of the 40,000 Microserfs and their 58,000 dependents in the Puget Sound area alone—the long-term rewards and savings can be substantial.

The Microsoft house call program, called Mobile Medicine, got its start in 2006 after a massive analysis of the company's health-care data. The team discovered that employees, like those at most companies, were using the emergency room mostly for non-life-threatening problems such as ear infections, skeletal bruises, and the flu.

Microsoft was already offering the Maserati of health plans. Employees usually don't pay a dime for a bevy of luxe offerings, including a weight-loss program that comes with personal coaches, behavioral therapists, and private dressing rooms in the gym to avoid locker room embarrassment. The goal behind the comprehensive health bennies is radical prevention: that it is cheaper to attack employees' health problems early rather than allowing them to metastasize into chronic, even costlier diseases.

COMPELLING SAVINGSAfter realizing how many employees were using the ER for basic maladies, the company figured there had to be a better and cheaper way of doing business. "We didn't just want to say to people, 'Don't go to the ER,'" says Julie Sheehy, Microsoft's wellness and productivity chief. "We wanted to get at the reasons why they were going to the ER and address those issues."

At the time, a Seattle medical company called Carena was exploring different delivery models for medical care. Carena was already dispatching family doctors for visits on-site at companies including Starwood and Costco (COST). Why not get Carena doctors to make Microsoft house calls?

Today, Carena physicians make some 350 house calls a month to Microsoft's Seattle employees. At a time when most natives in cubicle land are watching their employers whack benefits, Microserfs are having family doctors show up at their bedsides in the dead of night, sometimes even wearing a white lab coat and carrying a little black bag. The math makes a lot of sense for Microsoft. Trips to the emergency room average $1,500 a visit, according to the American Academy of Home Care Physicians. That's the cost of 10 house calls. Microsoft says the "housepitalists" are shaving approximately 35% off average ER bills, which make up the fastest-growing portion of health-care costs.

The strategy is part of a movement to give primary-care docs more responsibility to manage patients' treatments. The argument is that by getting more time with a doctor—perhaps even online—patients will be healthier in the long run. House calls enable doctors to examine patients in the context of their homes—a gold mine of clues.

Because home visits typically last up to an hour, compared with the 10 minutes most Americans are lucky to get at the doctor's office, studies show that physicians are better able to identify the underlying causes of a complaint and target which family members may be at risk. The doctors also serve as ambassadors to Microsoft's health plan, often signing patients up with a primary-care doctor on the spot.

What's more, house calls are playing an important role in health emergencies. Far better, Microsoft figures, to treat people for swine flu in their own homes than have them travel to the workplace, a hospital, or a doctor's office and infect others. "This isn't just a good benefit, it's an incredible benefit," says Microsoft attorney Ronald Rice, whose 5-year-old son recently saw a house call doctor for swine flu. "I recommended it to three of my co-workers whose kids also had flu symptoms."

The Carena doctors, who recently began making house calls to employees of Seattle-based Drugstore.com, have portable labs in their cars. That means they can turn a kitchen counter into a mini-clinic, capable of doing anything—strep throat culture, stress test—that can be done in a doctor's office. Christine Bennett, a Microsoft senior content manager, recently woke up in the middle of the night and discovered that her eyes had swollen shut. "I would have had to take my two kids and my husband, our whole family, to the ER," she says. Her husband called the help line. Within half an hour a doctor was at Bennett's side, diagnosing an eye infection and handing her an antibiotic. Says Bennett: "We were all back to sleep within two hours."

Private insurers, hospitals, and the Medicare program have all experimented with house calls for the elderly and chronically ill. The Independence at Home Act pending before Congress would increase the use of house calls for Medicare beneficiaries. Microsoft's Sheehy has also been inundated with requests from other companies who want to learn more. Says Sheehy: "It's kind of an old-fashioned idea, so people sometimes find it hard to grasp that it could be the way of the future."

Business Exchange: Read, save, and add content on BW's new Web 2.0 topic networkPity the DoctorsThe Centers for Disease Control & Prevention last month advised employers to do away with requirements that workers who have experienced flu-like symptoms provide a doctor's note prior to returning to the workplace. The CDC claims such policies are a burden on physicians who are already overwhelmed by the H1N1 flu pandemic.To view the CDC guidance, go to bx.businessweek.com/swine-flu/reference/
Conlin is the editor of the Working Life Dept. at BusinessWeek.

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