To our health

Tonight Dr. Bill Roper, CEO of UNC Health Care System, and Brad Wilson, CEO of Blue Cross Blue Shield North Carolina, will unveil plans for a new clinic that they expect will provide better patient care and reduce health-care costs. They’ll give their presentation at 6 p.m. in Town Council Chambers at Town Hall. No charge, of course. The talk also will be aired live on Channel 18 and via video streaming on the town’s website, for those of us who are couch or desk potatoes.

The planned clinic, Carolina Advanced Health, targets adults with chronic medical conditions. The idea is that all facets of a patient’s care will be in one building, making it easier for doctors to share information with one another about patients. The body’s systems work collaboratively; why can’t the system of practitioners?

A common scenario, one that many of us may deal with in coming years: To reduce stress on your heart, your cardiologist prescribes a diuretic; it prevents excess fluid from building up that the heart has to work harder to move around. The diuretic stresses your kidneys, because now they don’t have enough fluid to flush the toxins from your system. You end up with a kidney infection and to be rehydrated in the hospital in case rehydration throws you into congestive heart failure. Maybe if your cardiologist and renal specialist could communicate more conveniently, you could avoid the hospital stay.

What worries me more is that Chapel Hill has no place for the working class and poor new to Chapel Hill to receive non-emergency medical care. Granted, you could make the argument that no working class or poor people can afford to move to Chapel Hill, so this is a non-issue. But what about the people who are here and become poor, such as those of us who have recently cleaned out our bank accounts to pay property taxes or who have been the victim of job creators laying workers off to keep shareholders happy?

I grew up in a town that has a free health clinic, and I took it for granted. Last fall, when I looked around Chapel Hill and Carrboro to find a home for my mom’s rehabilitative equipment, no health care service had use for them. If you are poor and need a walker, Medicare or Medicaid will pay for a new one. If you can’t get on Medicare or Medicaid, you’re out of luck.

In Chapel Hill, our taxes take care of the vibrant and the wealthy: We have free buses and free art, and those who can afford hands-free cell phones or can be legally married will be exempt from a proposed law banning driving and phoning. I hope the CH2020 visioning process has a more inclusive view.
— Nancy Oates

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  1. Fred Black

     /  January 5, 2012

    You write, “In Chapel Hill, our taxes take care of the vibrant and the wealthy.” Nancy, it might be worth the time to examine where our tax dollars actually go: Police and fire services, $29.99/$100; Park and Rec services, $9.30/$100; Library services, $3.40/$100; General government services, $14/$100; Transit services, $8.39/$100; Environment and development services, $20/$100; and Debt service, $15.20/$100. So are you saying that these expenditures are only taking care of the “vibrant and the wealthy?”

  2. Nancy Oates

     /  January 5, 2012

    Bottom line is that despite our fine medical facilities, you have to have plenty of money if you’re going to avail yourself of them for anything other than emergency visits. The town is moving in the right direction with its proactive prevention program and on-site nurse or P.A. for employees. I wish we had a similar place in town for low-income people to learn about healthy habits or see a nurse about a sinus infection.

    It seems we rely only on state and federal money for social services. I don’t know how much of our taxes goes to making life better for the working poor. I hope it’s a respectable amount. It just doesn’t get the publicity that some of the problems of the wealthy do.

  3. Fred Black

     /  January 5, 2012

    Thanks for the clarification. This would have been a better statement to make than your original one, especially since it is just not accurate.

  4. DOM

     /  January 5, 2012

    “In Chapel Hill, our taxes take care of the vibrant and the wealthy: We have free buses and free art…”

    And don’t forget, we almost had free lifetime health insurance for every council member, past, present and future.

  5. Laurin

     /  January 5, 2012

    A good place to visit for the poor, homeless, out of work, etc. (and others!) for a wide range of medical and dental and pharmacy services is Piedmont Health Services in Carrboro, NC. I work there. Patients can pay on a sliding scale based on income. Services aren’t free, but are much cheaper than private practices. I have seen many homeless individuals and many of my patients actually don’t have jobs. I see such a wide variety of patients..patients who have been in the community for a long time (working or not), patients who have come as refugees from other countries, the Hispanic population, etc. It’s interesting how we are working with a microcosm of what makes this community unique…so many interesting people from all different walks of life. I was very interested to attend this particular event, and glad to see Piedmont’s CEO, Brian Toomey in attendance, as well.
    We have at Piedmont an interesting model somewhat similar to what was presented tonight at least in the medical sense: there are a variety of providers from different specialties, all under one roof, seeing the same patients. I often collaborate with the physicians and pharmacists there about high risk patients, and as a result the patient is able to get great continuity of care. I have had my differences particularly in how the dental department is run, but that’s only procedural stuff and I can tell you the quality of care is great. One problem now is that we have too many dental patients and not enough time….we are not taking new patients right now because we have to catch up to treat the ones we’ve got. Hopefully we can catch up soon and take new patients (speaking only for dental). There is such demand for low cost health care service…and we see that directly every day.

  6. Laurin does an excellent job laying the case out for why a significant chunk – 50% or more – of the 1/4 cent sales tax should have gone to needed human services. Demand for reliable and low cost health services in this economy is out-pacing a diminishing supply.

  7. Terri Buckner

     /  January 6, 2012

    The clinic Roper and Wilson described last night is a new business, operated and maintained jointly by UNC Healthcare and Blue Cross Blue Shield. The clinic, designed to provide general medical services to individuals with chronic disease, is available only to 5,000 BCBS patients and “a handful of state employees.” It’s an experiment to determine if the partnership can provide lower cost, higher quality care by having the medical care and payers work together rather than the normal relationship where contract agreements are negotiated annually. This new set up is supposed to give them more flexibility rather than setting them up as adversaries. They said they hope this model could work with other insurance carriers, including Medicare and Medicaid, in the future.

    The two organizations are sharing the costs and the cost savings (it sounds like they built a new building which is located at Hwy 54 and I-40 in Durham). However, they were very specific that the insurance premiums for these individuals will not be lowered as a result of better disease management so there is no financial incentive for individuals or businesses. It’s not that I think financial incentives should trump health benefits, but I don’t agree with Wilson when he said there is no way to lower health care costs to patients.

  8. George C

     /  January 6, 2012

    Hi Terri,

    I’m assuming that the clinic is probably set up in an existing building. The Quadrangle complex has been there for a number of years and there have previously been several biotech start-ups there so they would have wet lab space for some of the ancillary clinical lab functions that they would probably want on site. I didn’t get the impression from Brad Wilson’s comments that he was saying that health care costs couldn’t be lowered by this model – I thought he was saying that they weren’t going to change any of the costs to patients until after the model had been up and running for a few years and they had enough data to work with to determine whether they were actually realizing the hoped-for savings.

  9. Terri Buckner

     /  January 6, 2012

    George–what he said was that no one should think this was going to lower the cost of insurance premiums. He said the best that could be hoped for is lowering the slope on the trajectory of the rise, but not the rise itself. That sets insurance costs up as a positive feedback loop (constant growth) which is the basis for a future disaster (if we aren’t already there). He also said something about younger people having to get used to paying higher premiums ($350 vs $120), but I was distracted and didn’t hear all the full details.

  10. George C

     /  January 6, 2012

    Terri – if you lower the slope on the trajectory of the rise then you would obviously not be lowering the cost in absolute terms but you would indeed be lowering the cost compared to someone not enrolled in the program who would be dealing with a steeper slope. The reason why costs will, in all cases, continue to go up is the fact, according to Mr. Wilson, that unemployment in the healthcare sector is ~ 2% nationally. I’m not sure I’m willing at this point to accept de facto that personnel costs are the primary driving factor for increased health care costs but certainly they may be a significant one.
    The dramatic increase in health insurance premiums that Brad Wilson says younger people can expect to see is related to the full implementation in 2014 of The Patient Protection and Affordable Care Act, at which time costs of health care insurance for everyone will be distributed over a wide demographic.

  11. Terri Buckner

     /  January 6, 2012

    I think we should separate two costs: health care costs and insurance premium costs. Health care costs would include salaries, procedures, etc. Insurance premium costs may or may not be elastic in relation to health care costs. It’s been too many years since I took that health care economics class but I question what Miller stated as a given–insurance premium costs can only go up, regardless of wellness programs and or smarter treatment delivery such as the program they presented last night attempts to achieve.

  12. WJW

     /  January 6, 2012

    Mr. Black: Could you possibly post where you got your figures?

    I am looking at this web page ( with the 2010/2011 annual statement, and on a couple of your figures I can’t get close.

    My understanding (see page 8 of the annual report) that Chapel Hill spent $85.9M in operating expenses (NOT including capital expenditures) across ALL of the funds in 2010/2011.

    Of that $20.9M was for transportation or 24%. $2.1M was for interest expense (no principal payments included I assume) or 2%. $2.1M was for the Library or 2%. Public Safety was $20.4M or 24%.

    Do you have better information? Am I looking at the wrong page in the Town financials? Using the wrong spending number? Can you educate on what is the difference?

  13. George C

     /  January 6, 2012

    I agree that it’s hard to understand why increases in efficiency that are derived from better-designed delivery systems, uses of new technologies, and patient involvement in their own care cannot produce reductions in costs. Of course we might need to change some laws – like the 2006 one that prohibited Medicare from negotiating directly with drug companies even though the VA system can. As a result the VA often purchases drugs for as much as 1/10 the price Medicare does. Makes a lot of sense, doesn’t it?

  14. Nancy Oates

     /  January 6, 2012

    And change some policies (that is, standard procedure) at insurance companies. A physician friend says when a patient is referred to him, he has to run a new set of diagnostics in order to be able to bill insurance companies for reimbursement. So, if I as the patient have a health problem and go to my internist who does an MRI that shows a problem, and she refers me to a specialist, the specialist has to order a separate MRI as documentation for the treatment decisions he makes. A nurse has to draw a separate vial of blood for each specialist involved with a patient, instead of the various doctors sharing the results of one blood draw, so that each doctor can show that she ordered a blood draw to use as the basis for treatment recommendation.

    The new clinic is a move in the right direction, but like Terri, I’m having a hard time understanding why the savings can’t be passed along to the insured.

  15. George C

     /  January 6, 2012

    Nancy – Mr. Wilson and Dean Roper described this as a 3-year experiment for a novel system of health care delivery. I’m not sure that it is fair to ask them to cut costs to the recipients before it has been determined whether there actually are any cost savings. As we always tell our students, if you knew the answer you wouldn’t have to do the experiment.