GVHP Sticks With A Successful Model

October 5, 2007
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Grand Valley Health Plan was the first health maintenance organization in Grand Rapids, and after 25 years of operation it continues to be an innovator in comprehensive health care. Today, as always, GVHP takes a team approach to care, with a strong emphasis on prevention and wellness.

Gerald Bax, former administrator of the Veterans Facility, and Ron Palmer, former co-director of Grand Rapids Area Medical Education and founder of Sparta Health Center, established GVHP in April 1982. Their basic philosophy was to change the way health care was delivered. They went with a “staff model” HMO, which is a group practice that owns its own insurance company and health facilities and directly employs all its doctors and medical staff. 

“When we started the plan, we were very concerned about the payment for primary care services, especially prevention and wellness services, which insurance companies were not interested in paying for and are still resistant to paying for,” Palmer said. “We felt — and many of our physicians felt — that this was a very important base to develop with patients, and, in fact, that has turned out to be true.”

Because GVHP is both payor and provider of health services, the data it gains from the payor side really helps the provider side keep track of how the organization is performing, said Vice President of Medical Affairs James Kerby, M.D., who has been with GVHP since its inception. “It really gives us information in the feedback loop that we can use to make changes that will improve performance. We have a direct connection with the payor side, and we can influence the decision-making that goes on in terms of what is going to be provided for individual patients.”

Kerby recalled there was resistance to GVHP’s staff model early on. Furthermore, there weren’t many medical practices using mid-level practitioners to do primary care 25 years ago, but GVHP believed they played a significant role.

“That was one of the frameworks we thought would be important to introduce to the mix here,” he said. “A number of years ago, we also began developing our disease stage management programs, such as our diabetes program. It was a different context for a practice to be operating within at that time.”

GVHP has locations in Grand Rapids, Rockford, Jenison, Walker, Kentwood and Wyoming. The centers are expanded primary-care facilities: Each is fully staffed with doctors, nurses, physician assistants, nurse practitioners, wellness counselors, registered dieticians and behavioral health specialists. GVHP also operates an urgent care center, two in-house pharmacies, an outpatient surgical center, a diagnostic and radiology center, and the OB Center of Excellence. GVHP employs 26 physicians and also refers cases to 150 specialists.

The staff model, Palmer said, is really oriented around the risks to health that each patient has. The job of the GVHP team is to assist patients in lowering their risks. GVHP physicians see each other as consultants, whereas many physicians may practice in the same building without really talking to each other.

“What we try to do is have our physicians, staff and other providers work to come to consensus about how we’re going to manage different disease entities and to provide health care services,” Kerby remarked.

Palmer is proud of GVHP’s part in the evolution of the delivery of health care from a medical model to a health model that emphasizes prevention and wellness. This year, GVHP ranked No. 1 in Michigan among commercial health plans in 18 of the 22 quality of care categories benchmarked by the National Committee for Quality Assurance. It ranked among the top 10 percent nationally for all quality indicators among 250 reporting health plans and was No. 1 in four categories.

Staff-model HMOs typically rate high on patient satisfaction measures, according to HealthLeaders-InterStudy, a health care business information company that assesses geographic health care markets, providers and plans, noting that GVHP has shown “impressive” clinical outcomes in its diabetes care program. In 2005, NCQA rated GVHP the best in Michigan in five of seven measures in comprehensive diabetes care.

What direction will GVHP take over the next 25 years? That will depend on how the landscape of health care changes in the U.S., Palmer said.

“This is the only significantly industrialized country in the world without a national health care policy,” he pointed out. “Consequently, it’s very difficult to try to identify a broad perspective of where we’re going, because the country hasn’t decided where it’s going.”    

HQX

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