Sunday, October 11, 2009

End of the line for history-making HMO

By Robin Washington
Duluth News Tribune

Harold Leppink remembers when HMOs were HMOs.

And before that.

"We never called it an HMO. It was created long before the term HMO was," the retired Knife River physician said of Two Harbors' Community Health Center, where he worked from 1957 to 1970.

Now a part of FirstPlan, the health maintenance organization is no longer based at the Two Harbors clinic and will cease to exist at the end of the year. But once upon a time it was an innovator in preventive health care, which Community Health Center began offering in 1944.

"It was intended to be a health care cooperative," Leppink said. "It was spearheaded by people who worked for the railroad. When the railroad discontinued [running the clinic], the unions got together and decided to create their own plan."

When he joined, he said, a member would buy into it for $100 and pay monthly dues. Everything was covered, and if the clinic's six doctors couldn't perform a procedure, they made referrals to Duluth or to the Mayo Clinic, with Community Health Center picking up the tab.

The deal was members agreed to use the clinic for all their medical needs, except emergencies and specialties -- a model replicated by larger health care providers across the country. The emphasis truly was on keeping people well, even requiring members to have a yearly physical.

At least that's what I remember them doing.

"You are absolutely right," said Joyce Mireault, a vice president of FirstPlan in Duluth, confirming I wasn't dredging up false memories.

The inheritors of the Two Harbors clinic and its health plan, FirstPlan last year sold the clinic to Lake View Memorial Hospital and will shut down the plan at the end of the year.

Don't expect anyone to get teary-eyed. It bears little resemblance to its roots, and the wheels had started falling off all HMOs long before. Leppink recalled problems in the 1960s with the advent of Medicare, which reimbursed hospitals more readily than outpatient clinics. Eventually, HMOs began charging copayments for clinic visits and limiting coverage.

"Everything's covered except Robin's and Erin's asthma," I recalled being told in 1986 of my brief enrollment at Community Health Center — meaning my daughter and I could get treatment for everything except the main thing afflicting us.

By then, competitors and political opponents were already smelling blood and attacking HMOs, leveling specious charges such as "you won't be allowed to see any doctor you want."

Well, of course you couldn't — except for emergencies and specialties — and that was the point. Keeping care in house and keeping members well is what made HMOs work. When was the last time your insurance company demanded you come in for a physical?

By the 1990s, most HMOs capitulated and allowed members to go wherever they wanted. And while choice may be good, one result is "a lot of people wait until they have an issue and deal with it," as Mireault put it.

Among her company's new enterprises are programs to identify signs of chronic illness before a malady strikes and also to keep people well and out of the hospital — both reminiscent of the tiny Two Harbors model.

Would that have prevented our nation's health care woes today? Maybe — or not.

"Maybe some of the idealism wore off. Maybe the burden got too great to carry it. Maybe the pool wasn't big enough," Leppink said.

But it was better than what we have now.

Robin Washington is news director of the News Tribune. He may be reached at rwashington@duluthnews.com .