Montana opened its first government-run health clinics five years ago. It was touted as a bold experiment and a possible national model in providing low-cost health care to government workers. State employees and their families have no co-pays or deductibles for checkups and routine services. There were big promises of huge financial savings.
But a scathing state audit asserts that the clinics have failed to document measurable improvements in the health of state workers. What's more, legislative auditors said there is no proof the clinics have saved the state any money — despite claims to the contrary by the governor's office — partly because of inadequate record keeping that undermined the accuracy of any financial analysis.
"It didn't allow us to corroborate the cost savings advertised," said Nick Hill, a legislative analyst who was among the audit's authors.
The first of Montana's health centers opened in Helena in 2012 amid the national debate over revamping the country's health care system. The clinic, established under the administration of then-Gov. Brian Schweitzer, was heralded as the nation's first government-run health center.
Since then, five other states — Alabama, Kentucky, Tennessee, New Mexico and Missouri — have opened similar clinics.
As of August last year, Montana has spent more than $26.1 million to run the clinics, according to the audit, which was conducted by the legislative division and presented to an interim legislative committee last week.
The audit, conducted over a period of 20 months, noted "ongoing management challenges" and the absence of reliable data in which to assess the performance of the contractor hired by the state to oversee what is now a network of six clinics stretching from Missoula to Miles City. The audit also faulted the clinics for its cumbersome electronic medical records system, which sometimes prevent seamless sharing of health information between the clinics and other health care providers.
The director of the Department of Administration, John Lewis, defended the health centers by arguing that the audit failed to take into account many intangibles — including the immeasurable benefits of preventive care for the 34,000 state workers and their dependents who are eligible to use the health centers.
"Preventive care is a big part of the answer to finding savings to health care," he told the Legislative Audit Committee. "It's very difficult to calculate what those savings are."
The clinics help provide so-called medical homes for government workers, which encourage continuity of care and stronger relationships between patients and their doctors., supporters said. Much of the clinics' focus is on preventative care to head off conditions that could later require expensive treatment and to keep chronic conditions from exploding into even more serious maladies.
"It was very innovative idea at the time. And other states have followed," Lewis said, adding that "the state considers the clinics a success story."
Nevertheless, Lewis said, his agency will pursue the audit's key recommendations, including setting clearer goals and improving data collection to help establish measurable benchmarks not only in financial data but also health outcomes.