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Dr. Pate’s Prescription for Change

St. Luke’s Health System’s Journey to Transform Health Care

How Health Care Can Work

By Roya Camp, News and Community
June 7, 2016

I still vividly remember the call I received about 10 years ago from the CEO of an insurance company, asking for my help in selecting a physician at the hospital where I was CEO.

I responded that I did not believe that any of our physicians were covered by his insurance company. What I remember most clearly was his reply: “I know.”

It hit me like a ton of bricks. This CEO wanted different care for himself than what he was selling to his customers. Perhaps I was naïve, but I was shocked.

I have always received my care where I have worked. The fact that I feel comfortable recommending that anyone receive their care from St. Luke’s – family, friends, leaders of companies – allows me to sleep well at night and makes me proud every day.

We are building the system of care that we would want for ourselves, our families, our friends and our neighbors. It is what makes our work so special and meaningful. And when we access care from St. Luke’s, we get to see firsthand the impact of the care we are designing.

It makes our work very real. We experience our journey to transforming health care from the perspective of employees and patients. I have previously written about our care and caring during my wife’s surgery and hospitalization. Recently, my blog editor, Roya Camp, had the opportunity to experience our transforming healthcare system firsthand. Here is her perspective.

- David C. Pate, M.D., J.D.


For the past several years, I have written and edited hundreds of documents, reports, talks, presentations and accounts of what St. Luke’s is doing to shift health care in our region and the difference our organization hopes to make in undertaking the massive reform that St. Luke’s leadership has concluded is necessary in health care.

I believe they are right, and I believe the change is needed, but until very recently, I had no direct experience that health care as practiced within the St. Luke’s setting was any different than what I’ve grown accustomed to.

What I’m accustomed to, as others are, is what’s known in the healthcare world as “fee for service,” the Byzantine framework modern medicine has used to wrap costs around care. You go to the doctor’s office, something is done, you are billed.

Fee for service may have worked when health care was less complicated but it has backfired, and St. Luke’s is now trying to build a structure that reverses the order of things, agreeing to take responsibility for the health of a population and making its way on its ability to deliver efficient, top-quality care.   

Here’s how that worked for me during a recent visit to one of St. Luke’s clinics.

Two work colleagues came down with rashes, and one had been diagnosed with shingles. Recalling the oatmeal baths and extreme pain that my grandmother went through for nearly a year with shingles, because we are a small work group, and because these two co-workers and I share similar traits and characteristics, I decided I would get a shingles vaccine.

I went to one of St. Luke’s Saturday walk-in clinics. These are a relatively new development, far more convenient for me than the traditional Monday-through-Friday hours, and I appreciated that advantage.

But it was what happened while I was there that really gave me reason to think that St. Luke’s may really have grabbed hold of the future of health care.

By the time I was called in, my nurse had researched all aspects of the shingles vaccine as related to my age and condition. We had a very helpful and thoughtful discussion about the pros and cons of the vaccine in my case, the costs of the vaccine given the fact that it was not necessarily recommended for someone my age and the financial consequence of choosing the vaccine (Because it was not recommended for someone my age, my insurance would not cover it and I would need to pay for it outright. It is not a cheap shot.).

We talked about the chance of exposure, my general health condition and the tradeoffs of having the vaccine at this point in my life. It was a very empowering exchange. Not a persuasion, not a set of fear-inducing what-ifs, just a conversation. The nurse left the room to consult briefly with the physician on duty, and I could hear them having an equally thoughtful exchange. He concurred with our decision not to proceed with the vaccination. 

I have never been so happy to leave a medical office having done exactly nothing in my life. I have been raving about this positive non-experience ever since. Here you had a medical professional spend significant time helping a patient thoughtfully weigh tradeoffs, consulting with another medical professional, and in the end, getting paid nothing for the encounter. No one came out ahead, really, except me, and I feel as if I came out way ahead.

I am aware that there are many people who would think that, having visited a doctor’s office, they should have left changed in some way. There are many others who aren’t as fortunate as I am, in robust good health, able to calculate the minimal risk that I would contract shingles in this situation and comfortable with my odds.

But it was a very rewarding encounter, educational, empowering and, incredibly, free of charge. I have never felt better about the future of health care. St. Luke’s may actually be cracking the nut.


About The Author

Roya Camp is managing editor and executive communications coordinator for St. Luke’s Health System.