"One of the patients was found to have extreme diabetes. He was a walking sugar cube," Hill says. "He came in and said 'I am ready to change everything with my life. I am a smoker. I know I need to lose weight. I know I need to exercise more.' Our wellness coaches were able to work with him and develop a program. Rather than 'we are going to start this and you are going to get really sore in the first week trying to do all of this' they developed a year-long process for him to make lifestyle changes. That is a big difference for people to make a real lifestyle change."
It would be interesting to compare the cost effectiveness of Montana's clinics and their ilk with those of high-deductible plans – which are the exact opposite. Rather than encouraging enrollees to seek preventive and proactive medical care, high-deductible plans make access to care virtually unaffordable.
Low income wage-earners on high-deductible plans who have medical needs are forced to decide between a $100 urgent care visit (if they're lucky) and ignoring the problem with a hope for the best. It's a roll-the-dice strategy, but nothing good comes when people delay medical care because they can't afford it.
And it's a strategy that isn't gaining traction with Montana state employees. "We don't offer a high-deductible plan to our employees," Hill says. "We evaluate high-deductible plans every year and whether we want to go that route and at this point it has not been the route we need to go to manage our costs. We have found other ways to keep our costs under control."