Primaris CEO, Richard A. Royer

Keeping Health Care Healthy

Primaris’ mission: improve healthcare, assist Medicare users

It starts with a tingling in the back of your throat. Then a seemingly endless stream of liquid from the deep caverns of your nose comes forth, and pretty soon you’re dialing the doctor’s office for an appointment.

When a person gets sick, the doctor prescribes a treatment. But when the health care system is sick, Primaris is on call. The not-for-profit health care consulting firm frequently runs check-ups on hospitals, physicians, nursing homes and home-health agencies to make sure the industry is providing high-quality, cost-effective care.

“We have learned over the course of years to take complaints and other input we get from oversight, and gain quality improvement out of it,” said Dorothy Andrae, director of clinical review services and home health.

“That’s a very important linkage because our mission is to improve quality. If you just process complaints and then stamp them closed, you don’t get much out of that.”

Primaris has about 75 employees and is located on Keene Street just south of Columbia Regional Hospital. It holds Missouri’s contract for the Medicare Quality Improvement Organization and the contract for a program known as CLAIM that trains a network of volunteers to help Medicare enrollees navigate the system. Medicare is the U.S. government’s health insurance program for people 65 and older and/or disabled.

The nonprofit organization’s annual revenue has averaged about $7.2 million during the last five years. In 2007, Primaris’ revenue was $6.9 million.

Asked for an example of the work Primaris does, Andrae cited the case of a male patient who had a severe bacterial infection that went undetected because of a procedural flaw. The patient’s doctor ordered three urine tests for him at the hospital and expected the samples to be analyzed immediately. Instead, the task was not completed and the patient was discharged from the hospital.

Three days later his urine analysis identified dangerous levels of e coli in his urine. A computer program that was supposed to alert the staff about the patient’s incomplete tests failed to warn them.
Primaris looked at how the lesson learned could improve hospitals throughout Missouri.

In cases such as this, Primaris acts as the “quality control officer for a million Medicare patients across the state,” CEO Richard A. Royer said. But the consulting firm’s role doesn’t stop there.
Primaris has compiled a knowledge database of best practices that health care providers tap into.

After re-entering home-health services five years ago, the Audrain City-County Health Unit searched for a company that could inform them about current best practices.

“We needed to have some help and support, and we knew that quality was our main initiative,” administrator Kevin Lowrance said. “We’re in it for the patient, and I think with Primaris that’s true too. They’re also refreshing. With their quality initiative, they don’t push our noses in it.”

When Primaris hosted a conference on acute hospitalizations, Home Health and Hospice coordinator Arlinda Wilson learned that by identifying high-risk patients and teaching them to notify nurses of problems, the health unit could reduce the number of frequent hospital visits by the same patients.

“If you implement these programs, they said our numbers would go down,” Wilson said.

Audrain City-County Health Unit won an award from Primaris for health care improvements.

Royer said about 20 percent of Primaris’ work is devoted to Medicare’s beneficiary complaint process and Medicare education.
When CLAIM director Carol Beahan worked the Medicare helpline years ago, she heard a multitude of consumer concerns.

Medicare beneficiaries are often left bewildered by insurance plans administered through Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) and by Medicare savings accounts, she said.

Carol Beahan, director of CLAIM, reviews upcoming plans for educational events.

Before 1993, Medicare enrollees had to navigate the complicated system on their own. Once the CLAIM program was created, they had an organization to educate them. Primaris has held the contract since the program’s inception and says it has helped about 135,000 Missourians save an estimated $9 million in out-of-pocket expenses.

“When the opportunity came about for us to apply for this grant, it worked out well because we were working for Medicare beneficiaries in other ways to improve care already,” Beahan said.
A network of more than 250 volunteers keeps the CLAIM program running, taking what they call a beneficiary’s “shoebox” full of bills and sorting out what Medicare covers.

Primaris employees also work on statewide initiatives to educate both providers and patients on a variety of health issues from infections in hospitals to ways of reducing the number of patients frequently readmitted to hospitals.

Understanding what multi-faceted Primaris does can be as confusing as understanding the Medicare plan itself.
Originally located in Jefferson City, Primaris was formed in 1982 from two state medical societies. Primaris relocated about three years ago to Columbia, a better location for people traveling from the St. Louis and Kansas City areas. The not-for-profit was initially called the Professional Standards Review Organization, only practicing Medicare oversight. With passage of the 1986 Tax Equity Fiscal Responsibility Act and its implementation a few years later, the organization went through an overhaul and changed a portion of its identity.

“As that became implemented, Medicare began shifting our role,” Royer said.

When industry standards pitch and roll, Primaris adjusts. Due to changing Medicare policy, the nonprofit organization cut its workforce by more than half in the early ‘90s and reworked its business model.

“When you go from a company with 200 employees and six field offices to one office and 75 people, even over a course of several years, there is a lot of trauma,” Royer said. “A lot of people are going to be leaving. The systems are going to be changing. Your entire business model is going to be thrown on its head.”

With these challenges, Primaris’ strategy for over 26 years is maintaining a close interaction with health care providers. In its early years, Primaris had two employees living near clients; now they have 10 more field employees. The only way to survive, Royer said, is to be really in touch with your client base.

“Because we keep our finger on the pulse and we are close to our customers, I think we will always be changing—we have to be,” Andrae said. “By the nature of our work as a QIO, we have to respond to what the government wants. But we have to understand our providers enough to see what they need.”

Primaris Claim Volunteer Jayne Wikoff, goes over the generic $4 prescription costs with, Anne Mericle, a new Medicare patient.

Up until a few years ago, the Medicare system kept its programs separate from the private sector, Royer said. Since then, business interests with private groups have emerged as a burgeoning opportunity.

“Medicare didn’t want anything to do with them. They started changing that a few years ago, calling on QIOs to get more active with employer groups,” Royer said. “That is a new and opening area for us, so we’re very excited about that.”

Working to improve health care standards, Beahan said Primaris is the type of company that can be personally satisfying, even when benefits don’t come until years later. In 2003, Primaris joined a national smoking cessation program called Healthy Aging. At the time, Beahan was unsure how the program would impact lives.

“I didn’t know exactly what the outcome of that project was, but we participated in it with some of our health care providers in this area and it worked,” she said.