The city of London has turned to a medical group in Westchester County as a practical model when restructuring its health-care delivery system for 10 million citizens.
The group”™s CEO in White Plains thinks the local business community would do well to engage too with physicians in large group practices to shift the focus of health-care reform in this country.
In March, a London team headed by Sir Ara Darzi, professor of surgery at Imperial College and now the city”™s minister for health services, visited the Westchester Medical Group”™s central office at 210 Westchester Ave. Trailed by a video crew, Darzi toured the multispecialty facility with the 11-year-old group”™s founding president, Dr. Simeon A. Schwartz.
The Westchester Avenue clinic, the largest of  two clinics and six satellite offices operated by the 120-physician professional corporation, was chosen as a model for the community-based, integrated care that Darzi recommended to replace an inefficient system of small general practices and large acute-care hospitals in his subsequent report, Healthcare for London: A Framework for Action. That view of modern health care is shared by Schwartz.
“What our patients want is coordinated, quality, efficient care,” the 55-year-old, Yale-trained doctor said recently in his office in the hematology and oncology department at 210 Westchester. That has become a kind of business mantra for the approximately 500-employee, physician-run corporation he heads.
At 210 Westchester, that care is provided by a team of more than 50 doctors that includes more than 20 specialists. “Our patients like to call this one-stop shopping,” he told his London visitors. “They frequently refer to this as coming to a medical mall.”
In July, Schwartz was the only American physician invited to address the London conference at which the health-care report and action plan was presented. His presentation, “Happy Patients, Happy Doctors,” laid out the Westchester Medical Group”™s corporate organizational structure, coordinated clinical services and integrated electronic records system that have improved both patient care and physicians”™ and staff”™s income and professional satisfaction.
“I think they truly understood that this was about a delivery system,” Schwartz said of British health officials. “This was not just about coming up with new ways of moving money around and new insurance schemes.”
That delivery system needs a governance structure “where you get the physicians to work together and create the professionalism that”™s necessary,” he said.
Since the group”™s formation by 16 Westchester physicians in 1996, Schwartz has functioned as its business chief, overseeing an annual operating budget of $85 million to $90 million and reporting to an elected board of physicians. He balances his administrative duties with a hematology and oncology practice that has him seeing patients 20 hours a week.
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Mercantile family
Though he has no formal business training, “I grew up in a mercantile family,” he said. His Brooklyn family made suits and coats in the Lower East Side garment district. “Whatever I learned, I learned at the dinner table.” The doctor smiled. “I learned a lot. Business was a very important part of my childhood.”
“Medicine has never had the traditional corporate structure,” said Schwartz, who has broken that tradition in his leadership of Westchester Medical Group. “But you can”™t get coordination of care and you can”™t get the kind of capital investment and integration without having a governance model that is successful.”
England, he said, currently has no large physician groups such as the Westchester Medical Group or the county”™s largest physician practice, Mount Kisco Medical Group. Those two groups provide at least 200,000 persons with health care, he said, and account for about 25 percent of health-care practice in the county. Schwartz said there are from 100 to150 such large physician-governed organizations nationwide.
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Schwartz argued that many more such groups are needed to reform the health-care system. With their emphasis on small general practices of one or two doctors and large central hospitals, both England and the U.S. “don”™t have the right structures for delivery of physician services,” he said.
“There”™s a national debate about how to fix our health-care system,” he said. “Instead of looking only at who”™s paying, we should be looking at the system and looking at value-oriented health care. You can”™t do that without the organization. You really need organizational redesign and structural redesign. In order to look at value for health care, you need to have larger enough entities so that you could look at their whole delivery system and see if they”™re efficient.
“London came to the understanding that you will not create value unless you change the structure. The U.S. is still busy trying to figure out who pays, but the real question isn”™t who pays, it”™s who pays for what?”
Health-care costs in the U.S. are twice those in England, Schwartz said. Yet the average life span in Britain is the same as in America. For insured citizens in the U.S., “Much of the care is unnecessary or a luxury,” he said.
Schwartz, who sits on the national physician advisory committee at Wellpoint Inc., the parent company of Blue Cross and Blue Shield, said that that 15 percent of the total cost of those health insurers”™ premiums “is going for sales, administration and profit,” compared with a 3 percent administrative overhead in the federal Medicare program.
He said he has challenged those and other health insurers “to convince the business community that they”™re worth it, that they”™re providing value for that 15 percent. That”™s an enormous amount of money. I think that”™s for an employer and others paying the bills to decide if they”™re getting value for that.”
“The question for the business community in Westchester is, are they serving their business needs the best by delegating to the insurance companies the assessment of health care value? The business community needs to decide whether they”™re going to be a passive or active participant in this. In this country, business is paying the bills right now” for health care.
“Ultimately, business has to enter into relations with large health-care providers to begin the discussion of value,” he said. “There”™s no reason that Westchester County should not have the best, the most efficient health care in the U.S. We have plenty of doctors, good hospitals and a committed business community. If we can”™t get it right, who”™s going to get it right?”
At Westchester Medical Group, a prostate cancer patient told the London visitors and video crew that physicians there got it right with their one-stop-shopping approach to medical care. “I recommend it highly,” the patient said. “I think it”™s the greatest thing since the invention of peanut butter.”
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