As an undergraduate student at Simmons College in Boston, Jane E. Niederberger worked a part-time job a block away at Harvard Community Health Plan doing market research, processing claims and opening lots of mail.
She soon found a full-time job at the forward-thinking HMO as a pioneer among pioneers in the field of quality-of-care measurement. It was a long way from information systems development, but Niederberger would later apply the same approach to information systems that she learned as a performance-measurement specialist: Think of the plan member first.
Now the chief information officer of Anthem, an Indianapolis-based Blue Cross and Blue Shield company operating in eight states, Niederberger says technology is not about staying current with the latest inventions but about solving the difficult problems of adjudicating claims and developing standard insurance products across numerous states with differing laws and markets.
"We need to do things faster, better, cheaper while serving our members," she says.
Niederberger was educated to evaluate and meet the needs of people, graduating from Simmons in 1982 with a degree in nutrition. But she gravitated back to health maintenance, rejoining Harvard Community within a year.
It was 1983, and the HMO was getting ready to take a then-novel step beyond the usual benefits marketing and administration. It wanted to evaluate how -- or whether -- those benefits resulted in effective care.
Early mentor. Hired originally by the marketing department as a health statement reviewer, Niederberger was selected as the first employee of a Harvard Community physician who started the new quality department. His name: Donald Berwick.
She would work with him for nearly 10 years, during which measurement of medical outcomes of care would develop into a major field and Berwick would become a leading figure in it. Now president of the Institute for Healthcare Improvement, a Boston-based not-for-profit organization founded in 1991, he was a prominent contributor to the report published last November by the Washington-based Institute of Medicine that raised awareness of the tens of thousands of deaths attributed to medical errors each year.
Berwick is known for asserting that any delivery system is set up to produce the outcomes that are measured and that if those outcomes are unsatisfactory, it's the system that needs fixing.
Harvard Community fanned out in numerous directions to increase the odds of registering good results. Its efforts included improving management of conditions such as asthma and diabetes, questioning previously unquestioned practices such as repeat C-section births and fostering the importance of preventive health measures such as pediatric immunizations.
"My job was not only to sit and think through these ideas but come up with a way of putting them into practice," she says.
As manager of operations, she directed the activities of 60 people in establishing and managing relationships with clinicians, senior managers and other medical staff working in more than 50 sites.
The quality-of-care department was reorganized as the clinical care assessment department in 1991 for the "next generation" of quality management, becoming less "researchy" and more concerned with the practical elements of integrating the research into medical practice, she says.
Much of the work on measures bolstered the emerging Health Plan Employer Data and Information Set, or HEDIS, an attempt to standardize employers' demands for HMO quality and business performance statistics. Niederberger chaired a New England HEDIS Coalition subcommittee, and she was project manager of Harvard Community's first HEDIS report.
Switching gears. When Harvard Community announced in mid-1994 it would merge with competitor Pilgrim Health Care to form Harvard Pilgrim Health Care, Niederberger says it prompted her to start thinking about a career change. That's when her attention to performance paid off in a different way.
The HMO's information technology department was well-acquainted with Niederberger. "I was a total nemesis for our IT organization," she remembers. "I was always telling them what they did wrong."
So the CIO at the time, Cecilia Claudio, recruited her to manage the process of evaluating and selecting new information systems for clinical purposes. Niederberger eventually was promoted to director of all business development activities involving information technology, including sales, clinical operations, case management and practice management.
Claudio moved to Anthem and recruited Niederberger in January 1997 to help transform the company from an indemnity insurer to a managed-care organization.
Path to the top. Seven months later Niederberger was promoted to vice president of new business solutions, charged with the additional responsibility of directing a staff of 180 information professionals in the development and deployment of technology. She became acting CIO when Claudio left in July 1998 and was officially appointed CIO in February 1999.
Anthem had some false starts trying to build a core managed-care information system internally, setting back plans to support the reordering of the company's business. Niederberger was faced with finding a commercially available system in short order.
The choice of a system called Facets, from Erisco Corp., caused some concern among the technically minded people in the information technology department who said it wasn't leading-edge enough, she says.
But it wasn't a technology-minded decision. The eight senior managers who reviewed the choices and heard the finalists make their case were more concerned about how well the system would advance their managed-care strategy, how comfortable the work force would be with the technology and how financially steady the system's maker appeared to be, Niederberger says.
"We wanted to leverage technology to better serve our members," she says. If the system at the point of service can't deliver, "it's not the programmer that's affected, it's the mother with three crying children."