As a member of the Kaiser Permanente HMO in northern California, heart patient Roshni Nand is the exception. Nationwide, heart disease is the leading cause of death, but not for the 3 million members of Kaiser, where it is a stunning 30 percent lower than the rest of California.
It's the result of a simple formula, says Dr. Eleanor Levin.
"Make sure they're on all the right medications," says Levin, a cardiologist with Kaiser Permanente of northern California. "That they're doing the right lifestyle changes in terms of weight loss, stress reduction, smoking cessation and the right diet."
It's about preventing problems, instead of just reacting to them. It's a coordinated approach reinforced to patients like Nand by doctors and in free classes.
"Your vascular surgeon and your internist and your cardiologist are all giving you the same message," says Levin.
So what's Kaiser's secret weapon? A $3 billion computer network that gives doctors instant information about X-rays and lab tests, and eliminates hard-to-read prescription orders.
"They can simply, with a few clicks, order the medications, order the tests — even the consultations," says Dr. Louise Liang, senior vice president of Kaiser Permanente.
This integration of medicine and technology in Oakland, Calif., is attracting worldwide interest from Britain's national health service to the Bush administration. Everyone wants to see if Kaiser is a model for the future.
"The kind of coordination that Kaiser has achieved has set a very high standard and shows us, I think, in many cases, what's possible," says Margaret O'Kane, president of the National Committee for Quality Assurance.
It's all a far cry from the 1990s when Kaiser, like many others, was dogged by accusations of putting costs before care. Now, it uses technology to identify issues before they become headlines.
"We actually removed Vioxx as a medication for our patients before the FDA pulled it," says Liang.
It's a different way of delivering care, but it's also a different way of doing business. Instead of paying doctors for each service they perform, physicians earn a salary, with bonuses for keeping people healthy. But experts say adopting such a model would take a monumental shift in the health care industry.
"What we pay for in medical care is for doing things — for operating on patients, for prescription drugs ... insurers earn more when their patients do more," says David Cutler, a professor at Harvard University. "But nobody earns more when the patients are healthier."
But Kaiser says its influence is felt in northern California, where costs are 25 percent less than the New York area.
"We're able to keep our members healthier; therefore, it costs less to take care of them," says Dr. Francis J. Crosson, executive director of the Permanente Foundation.
For patients like Nand, it all adds up to crucial support as she lives with a chronic disease.