"I think the cost has to do with how much people are using the hospital," said Don Yost, storyteller at Maple City. "The quality and quantity of our primary care means that people are using the hospital less."

THE NUMBERS

The average monthly cost for Medicaid patients who went to Maple City in the first six months of 2008 was $59, 39 percent less than the state's average per patient on Medicaid, $97.

"Most providers see Medicaid patients as a money-losing proposition," Yost said. "Our costs are so low that we do better with our Medicaid patients than the people that are not insured."

Some private practices don't want to see Medicaid patients, and instead of receiving primary care, they end up in the hospital. That means bigger expenses for Medicaid to cover.

WHERE THEY SPEND MORE

Officials at Maple City say they are investing more money in the community, treating medical care as a relationship, encouraging office visits and follow-ups with doctors, providing counseling, disease management, breastfeeding and prenatal coaching, and measuring the effects of treatments.

The most expensive categories of care are family practice, internal medicine, pediatrics and OB/GYN. For example, in family practice, the state average per month is $6. Maple City's is $22.

DEMOGRAPHICS

In 2008, 33 percent of Maple City's patients were uninsured, 28 percent had private insurance and 39 percent were on Medicaid.

HOW DO THEY DO IT?

Develop relationships with patients. If they trust you, they will come back to you if something isn't right.

"What we have here is relationships with patients," Gingrich said. "They have a medical home here. They know us."

Prescribe generic drugs. New drugs are often more expensive, modernized versions of older drugs, Maple City Health Care Center Medical Director James Gingrich said. "If we can get it for them for $5 a month instead of $50 a month, most of our patients are willing to take it twice a day instead of once a day," he said.

Maple City's costs for prescription drugs is one-third the state average.

Measure quality. Monitor the patient's condition, what medicine was prescribed and the outcome.

Integrate care. Treat the patient as a whole, including offering counseling, social work, Medicaid enrollment and chronic disease management.

WHAT CAN OTHER CLINICS LEARN?

Most health care operations function primarily in a market-driven environment, Gingrich said.

"The care they give is essentially a commodity," he said. "They tend to think of office visits as a commodity they sell."

In general, the health care industry in the United States needs to change to be structured around care rather than making money, like Maple City, he said.

"The bottom line still is, good quality care is basically still cheap. If we oriented our health care in this way instead of focusing on specialists and focus on primary health care in a primary care context ... we could significantly reduce the cost and significantly improve the outcomes in our country," he said.