Employers that want to improve the healthcare delivery system have begun to realize they'll need the help of providers to measure their progress.
As a result, employer groups are establishing new organizations and inviting providers to help them sort out the answers to thorny questions. They want to find out about the gathering and consumer use of healthcare information that's likely to be part of an electronic data "highway."
This newfound cooperation goes beyond the formation of health alliances, in which buyers reach agreements with selected providers to provide healthcare to employees at a prenegotiated price. Such agreements have occurred recently in Chicago and Kenosha, Wis. (Jan. 3, p. 16; Jan. 24, p. 17).
Many more such purchasing agreements are likely to occur in the 140 cities in which business groups have formed coalitions on healthcare to address such issues as cost and quality.
Hospitals and physicians often aren't included in these coalitions because "businesses want to be in the driver's seat" to negotiate the most favorable coverage, said Richard Rubin, executive director of the Foundation for Health Care Quality in Seattle.
It's becoming another story when clinical information is concerned. "Purchasers and providers may disagree on fundamental issues, such as access and cost containment. But to discuss issues of quality and measurement information, there's a clear need for participation and collaboration," Mr. Rubin said.
The Seattle foundation, which includes providers, has become the focal point for the Community Health Management Initiative. That project is developing a "paperless" electronic information system that will accelerate claims payments and provide quality and performance data for the public's use, said Mr. Rubin, who became executive director on Jan. 1.
A group of Seattle physicians is identifying an initial set of clinical data for collection by the project, which has a two-year budget of nearly $1 million. Of that amount, $650,000 represents a grant from the Hartford Foundation. The Seattle-based Health Care Purchasers Association, with more than 100 Washington state employers, is a major sponsor of the project.
In Memphis, Tenn., the MidSouth Health Care Alliance has received a $1 million Hartford Foundation grant to develop and maintain an electronic information system to develop quality report cards for Shelby County consumers. The alliance includes providers as well as healthcare buyers.
"Providers have to be made an active part of the planning process," said Ronald L. Beford, director of Michigan Health Management Information Services, a broad-based collaborative planning effort sponsored by the Greater Detroit Area Health Council.
The council so far is the only one of some 14 coalitions in Michigan that permits provider groups to be members.
However, a group of three coalitions in western Michigan involving 100,000 employees and their dependents is moving ahead on an electronic data interchange project that promises to cut administrative costs and guarantee payment of claims within 72 hours of submission, said Debra Huber, vice president of sales and marketing for Boulder, Colo.-based System One Corp., a wholly owned subsidiary of Banc One Corp., Columbus.
System One, formerly known as Croghan & Associates, will employ standard banking security techniques to screen out users who don't have the authority to view patients' records, Ms. Huber said. The project-which involves business coalitions in Grand Rapids, Muskegon and Holland, Mich.; 4,000 physicians and other practitioners; and seven hospitals-is scheduled to start operations in July.
Eventually, payers will use the data to select the most efficient local hospitals and physicians.
That process finally may have begun in Cleveland, where providers and employers have spent three years and $10 million developing a quality "report card" on 30 local hospitals.
Patrick J. Casey, executive director of the Health Action Council, an employer coalition, said some Cleveland businesses have asked insurers to begin using the reports to screen hospitals that want to be included in new preferred provider networks. In several cases, hospitals with poor scores weren't included, "but they never knew they lost (the business)," he said.