Defining health co-ops

Dr. Jack Dutzar has nothing but good things to say about his former employer Group Health Cooperative, the health care system in Washington state that is under the spotlight as an example of health co-ops that could play a role in revamping the nation's health care system. But he's not sure people understand what kind of a co-op it is or how it achieves it success.

"I think they do a great job," Dutzar said about Group Health, where he was executive medical director of its Columbia Region before becoming president and chief executive of the 240-physician Fallon Clinic in Worcester last year.

Group Health's model is to provide care to keep people healthy, manage their chronic illnesses to reduce hospital utilization, and avoid unnecessary care.

"You do not have to go to Seattle to find that," he said. "You can find it in Boston at Harvard Vanguard, you can find it in Worcester at Fallon, and you can find it at a variety of places in the Commonwealth. Loosely using the word 'co-op' is little confusing because it implies economic participation by the patients."

What makes Group Health a cooperative is its consumer governance. That means members, who buy Group Health insurance through their employers or get coverage through government programs such as Medicare or Medicaid, vote for the board of trustees.

While patients' having a voice is important, Dutzar said, it's different from a rural cooperative, for example, in which people pool payments and receive discounts on gas or fertilizer rather than profits.

"I believe Group Health is a tremendous model for the country to potentially emulate, but I don't think it's a cooperative in the sense that most people understand," he said.

What really makes Group Health successful is the way it takes care of its patients, Dutzar said.

"Group Health provides all the necessary care that people need so they stay healthy, reducing hospital utilization, reducing poor results from chronic illnesses, as opposed to providing more and more services ... that don't add value to one's health," he said.

Dutzar is a veteran of health care debates, having gone to Washington, D.C., for Group Health to participate in health care talks during the Clinton administration.

"There's a certain recycling of the conversation here," he said. "I applaud the Obama administration on this, and I certainly applaud the Massachusetts leadership because at some level they've stepped off the curb and taken the issue on in advance of the rest of the country."