Navigating the Maze: Ensuring Appropriate Care for Employees with Complex Health Conditions

BY Matthew Koehler | May 29, 2024

Heidi Guetzkow, vice president within Aon's health transformation team, knows the difficulty in finding the right solution to complex, sometimes impossible, diagnoses, and sees herself as a puzzle master. “How do we put it all together and come up with some really good insights? And even more importantly, how do we figure out and identify the right resources for members and their employees during one of the most difficult times in their life, when they’ve had a difficult diagnosis.”

Guetzkow provides guidance in worksite well-being strategy, targeted risk reduction programs, and improved access to care solutions including employer sponsored clinics. At From Day One’s conference in Chicago, she spoke with Todd Kor, M.D. an anesthesiologist at Mayo Clinic to discuss some of the differences between routine and complex care.

Complex Care: What and Who?

“People oftentimes will ask, what are complex cases? What does that really mean? If you think along the continuum of medical conditions, routine conditions that people see the regular doctor on an infrequent basis. That’s not what we’re talking about.” Complex cases are the rare cancers and diseases where you're not getting answers from your local provider, says Kor.

Guetzkow says that within the realm of the workforce, when complex care is needed for a worker, you’re not looking at thousands of patients, it may just be one person. But that one person's devastating diagnosis has the potential to affect the whole team, or company, and their family. Especially financially.

“If my kid breaks an arm, I want to get to the best orthopedic place as soon as possible. The same really should be true when we think about these complex care conditions. And oftentimes, as the employer, we don’t get the chance to be able to make those decisions and we get stuck in a smaller network, or have to be in a regional place of care, and not always have access to the full scope of experts," Guetzkow said.

People can incur a lot of debt trying to figure out the correct diagnosis, which Kor says is one reason to consider a place like the Mayo Clinic early on. Accuracy and correct diagnosis aren’t the only benefits, Mayo Clinic also has access to clinical trials, new innovations, and new technologies.

Todd Kor, M.D, Anesthesiologist, Associate Medical Director Contracting & Payer Relations at Mayo Clinic spoke with Heidi Guetzkow, Vice President, Aon Health Transformation Team during the thought leadership spotlight 

"What we find is that not infrequently, patients are referred to us after that cost curve is already established, the sooner that you can engage with us the better,” Kor said. For example, of the people referred to them for spine surgery, half don’t actually need surgery. Another condition referred to Mayo frequently is multiple sclerosis (MS), but "roughly two thirds of them are found to either not have MS" or have something else. For prostate cancer, they can reduce your radiation oncology visits by more than half.

“Some of these things that even may appear to be sort of mid pyramid care topics, I would encourage think early because the sooner that you intervene, the sooner that you introduce them to a Mayo Clinic, the sooner that we can bend that cost curve, get the accurate diagnosis, and then on their way back to recovery as quickly as possible.”

Eliminating Lost Time and Cost

Lost time searching for the right diagnosis, or getting the wrong treatment for the wrong diagnosis, is a major problem, says Guetzkow. “How much time are people spending spinning in the system without being on the right course of treatment, for instance, over diagnosis or over imaging, it's just waste. And ultimately, what we really want is getting people to the right place of care, and really what is required of them.”

Kor says the first thing they do is provide a condensed itinerary. He referred back to his 20 years of private practice where if someone had to get a new lump checked out, and it turned out to be malignant, the timeframe from first visiting a doctor to seeing a specialist could take months.

“One of the things that’s unique about Mayo Clinic is that we take care of patients from over 150 countries and all 50 states. Because of that, we don't have the luxury of telling patients to come back every two weeks.” He says that you could be seeing all the specialists you're traditionally going to see for a cancer screening all in one day. “We oftentimes are able to see you at the beginning of a week, and you're having your surgery, and resection of whatever you're there for by the end of the week.”

Kor points out that one of the benefits of the condensed schedule is that patients can very quickly return home, where they usually recover best. “We’ve got this really robust concierge service that helps the families. It’s not just the patients that are coming for care. It’s really the entire family unit, as well as all of the downstream other individuals, whether it's their employers, their other family members.”

Kor says that part of the success of their model is that care is based on quality, not quantity. They are also salaried. “I have zero incentive to see more patients to do things that are inappropriate. To order tests that I don't need. Even the review process. You refer to Mayo Clinic, we review that chart. Some we accept, some we don’t. We’re not out begging for patients, because we actually have enough demand and capacity that we don’t need to do that.”

“What [we] really focus on is, ‘Can I help the patient with a condition that they have?’ If the answer is yes, we figure out how to take care of the patient. If the answer is no, that they're better served locally, or if there's no reason that they would need the elevated level of care, then we encourage those patients to stay where they are,” Kor said.

Guetzkow spoke about her own experiences with Mayo and the care they provided to her brother-in-law and father. Even though both have passed, she couldn't stress enough “the care they received, not only for themselves, but also the information that the family received and just the experience in itself.”

“I have another journey coming up. My mother-in-law is going to receive a cochlear implant on May 21. And she just had her workup appointments again, all condensed into one day, and it was super efficient. She knew exactly what she was getting, and had all her appointments and now has her surgery scheduled.”

Editor's note: From Day One thanks our partner, Mayo Clinic, for sponsoring this thought leadership spotlight. 

Matthew Koheler is a freelance journalist and licensed real estate agent based in Washington, DC. His work has appeared in Greater Greater Washington, The Washington Post, The Southwester, and Walking Cinema, among others.

 

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