For years, Crohn’s disease weakened Ed Reus’ immune system and left him susceptible to infections. One morning in 2001, he lacked energy to even get out of bed. His breathing became labored. He developed a cough that sounded “wet.”

His worried wife called his primary care physician at WellMed, Dr. Marlene Sanchez, who wanted Ed hospitalized immediately so she could order a nuclear scan of his lungs. He protested.

“She told me that if he refused to go, I should call 911 and have the paramedics come get him,” Annette Reus recalled. “He heard Dr. Sanchez talking to me, the urgency in her voice, and that convinced him to go.”

The scan confirmed Sanchez’s suspicions: A potentially fatal blood clot had traveled from Ed’s leg to his lungs. He was successfully treated and recovered. The Reus’ recently celebrated Ed’s 74th birthday and judged a seniors beauty pageant in Irving.

Annette credits Sanchez for saving Ed’s life and for acting as a catalyst that keeps him thriving in their golden years.

“We have seen an abundance of doctors, from the cancer doctors to the dermatologist, gastroenterologist, the blood doctor, the heart specialist – Ed has gone through it all,” said Annette, whose husband once was considered terminally ill. “And they’ve all been coordinated by his primary care doctor. I’ve been to other doctors outside of WellMed and you don’t get the feeling they are communicating like this.”

These stories are common at WellMed, a leading primary care provider for Medicare-eligible seniors in the San Antonio area, with 21 clinics in the region. The health care company continuously strives to improve an innovative, coordinated team approach emphasizing preventive health care for seniors.

“When I founded this company in 1990, I had already been in practice for 10 years and basically had reached a point of frustration, because at the time ... the entire focus was on fixing what was broken,” said Dr. George M. Rapier III, who leads WellMed as chairman and CEO. “There was essentially no focus on prevention, and there was really no focus on helping people live better lives.”

Perfecting the Medical Home

The health care delivery model Rapier built at WellMed puts the patient at the center of a team directed by a primary care physician. The team may include a nurse, health coach, hospitalist, social service worker and physician assistant. Leading medical societies such as the American Osteopathic Association and American Academy of Family Physicians advocate this approach, called the patient-centered medical home.

“We really do have to bring back the old-time primary care doctor who cared about you, who was concerned about you, who was part of your family, and you were part of their family,” Rapier said. “It’s a primary care physician who knows all about you. So if you need a specialist, they know the best specialist to send you to. If you need to go in the hospital, they make sure you get the appropriate care in the hospital. They are your coordinator of care. And that’s really the concept of a medical home.”

Traditional health care rewards doctors based on the number of patients treated, but financial incentives at WellMed are partially tied to health quality targets. This encourages physicians to spend more time visiting with them (about twice the national average) and studying their medical history, leading to more effective treatment.

Helping Patients Leap Hurdles to Quality Care

WellMed also helps patients by eliminating barriers to quality care. In addition to complimentary flu shots, many WellMed patients qualify for no-cost medical transportation, which dramatically improved the “show” rate at clinics.

Many patients receive a complimentary state-of-the-art electronic medical record device that fits on a key chain or rubber wristband, giving emergency medical personnel immediate access via a secure Internet site to a patient’s medical record summary with most recent medical records, allergy and prescription information and more.

Some WellMed clinics have in-house pharmacies and prescriptions can also be mailed. But for years, prescriptions for life-improving or disease-managing medications went unfilled.

“About five years ago, we looked at our patients with chronic diseases— diabetes, heart disease, lung disease and heart failure— and at the medicines they were getting filled,” Rapier said. “We were absolutely shocked by what we saw. The fill rate on those chronic drugs was less than 20 percent, meaning the seniors were getting them filled only one time in five when they had been prescribed.

“So we asked why, and it was money. They couldn’t afford to buy them and their groceries or buy them and pay their utility bill.”

WellMed leaders decided to underwrite prescription co-pays for many drugs that treat chronic disease. WellMed invested $4 million this year in that program, which also pays fully for prescriptions if insurance coverage for the year runs out.

Today, nearly 90 percent of these patients pick up prescriptions, a positive reversal that contributes to better health outcomes. On average, bad cholesterol levels dropped from dangerously high counts to numbers deemed optimal by the American Heart Association. Hospitalization rates fell while patient satisfaction at clinics hovers above 95 percent.

Recognition Worthy Of Study

The results have not gone unnoticed. The Disease Management Association of America recognized WellMed in 2008 with a quality improvement award. Modern Physician, a leading online news Web site for health care executives and professionals, recently named Rapier its 2009 Physician Entrepreneur of the Year “for his central role in creating a company that takes better care of patients and makes money doing it.”

A study of WellMed as a medical home model funded by the Federal Agency for Healthcare Research and Quality is being conducted by The Robert Graham Center, the research policy arm of the American Academy of Family Physicians.

Dr. Robert Phillips, Graham Center director, said Congress has great interest in the medical home because of its promise in delivering highest quality care at the lowest possible cost, yet few examples are cited outside the Mayo Clinic and Cleveland Clinic.

That’s one reason for the current study, said Phillips, vice chair of the U.S. Council on Graduate Medical Education, which advises Congress and the president on physician workforce policy.

“There is good evidence that the clinics that incorporate the elements of the medical home save money and improve quality and improve satisfaction for patients and providers,” he said during an October visit. “The more I learn about Dr. Rapier and WellMed and the vision and effort that got them here, the more impressed I am.”

WellMed is now involved in a five-year medical pilot program with the City of San Antonio. Earlier this year, WellMed was the winning applicant to provide free health screenings and health education services at senior one-stop, multi-service centers in Districts 4 (Southeast San Antonio), 5 (West Side) and 10 (North East).

The services focus on preventive care programs designed to improve quality of life for seniors while decreasing annual health costs. WellMed also offers these services at the Elvira Cisneros Senior Community Center by WellMed on the South Side.