IBM is bullish on plans to involve employees in better managing their healthcare spending, one of the topics of research by the Health Care Delivery Policy Program, a forum created by Harvard University's Kennedy School of Government.
Susan Piper, manager of health benefits at IBM, says the company has a robust Web site offering a suite of health benefit tools to its employees. This year, IBM is introducing a medical cost estimator to help employees predict their medical costs and decide which IBM plan is best for them. Piper says in 2004, Fidelity Employer Services Company, which administers health plans for IBM, will adapt and offer this tool to other companies they support.
"We're using technology to empower employees to become better healthcare consumers," Piper says.
The market will support those initiatives that work and are embraced by patients with different needs and values, says Richard Migliori, M.D., CEO of United Resource Networks, a specialty care division of UnitedHealth Group, Minnetonka, Minn.
Previously the chief clinical strategist for Ingenix, UnitedHealth's information technology unit, Migliori was invited to the Harvard group to advise its members about better decision support systems. His expertise is in using technology to reduce fragmentation, geographical variation. He says the "chasm" between what patients expect and what they get is widened by inefficient administrative systems and rapidly growing clinical knowledge requirements.
"In (the Harvard) group, the focus is on trying to understand those aspects of healthcare delivery, rather than healthcare technology, which will be required to start bridging the gaps," Migliori says. "It's not on designing new technology to treat disease, but on better processes for conducting that care."
The banking and airline industries have been through this already, he says. In those industries, the demands for quality are every bit as important as in medicine, where failure can result in loss of life and limb. Likewise, expectations from the customer are perfection.
"By looking at other industries, it helps us break the notion that healthcare is special or unique," Migliori says. "It may be a more sophisticated problem, but the underlying principles will be the same."
The Harvard group also is exploring how healthcare might become self-regulated to promote quality and safety.
"I'm of the bias that the entire industry, given the right information, will do the right thing," Migliori says. "But we need the infrastructure of other self-regulating industries."
The program is working with the National Association of Security Dealers and the U.S. Securities Exchange Commission to study whether their models for transparent oversight could work to oversee 775,000 licensed healthcare providers, Grossman says. Similarly, the program is looking at the Federal Aviation Administration and the National Transportation Safety Board for strategies to assure medical safety.
The SEC is a relatively small agency that deems licensing status to the NASD, a private, self-regulating organization that licenses almost three-quarters of a million financial brokers and dealers. The NASD also carries out an arbitration function for grievances and sets the standards by which its members operate.
Likewise, the National Committee for Quality Assurance holds deemed status from CMS to assess quality in healthcare. Grossman wants to know, are there aspects of the NASD that might affect how NCQA could work? Maybe NASD could help NCQA be better, faster and cheaper in assessing health plans, and eventually, physicians, Grossman says.
"We think that studying how NASD works may also be useful in finding a safe middle ground for releasing information about medical errors, where arbitration is a fair method of assessing what went on and might well open people up to getting the care right," he says.
In terms of safety, Grossman says the Federal Aviation Administration, which sets airline standards based on studies conducted at NASA-run laboratories, could further influence the work of the Joint Commission on Accreditation of Healthcare Organizations.
"The FAA takes data from accidents or near misses to show where they relate," Grossman says. He advocates a healthcare system that would allow providers to share information about near misses and failures with which an organization like JCAHO could set standards for improvement.
"If you use the FAA safety model, in order for you to offer your product to the market, you have to pass FAA standards," Grossman says. "That could be what a modified JCAHO might do. The government might have safety labs that learn from reports on errors."
The Harvard group is advocating for more controlled, protected experiments to see if delivery reform could work, and Grossman says CMS is on the right track with its Medicare and Medicaid demonstration waiver projects.
"It is easier to ask for a waiver for a tightly controlled experiment than to change the law," Grossman says. "We look at ourselves as facilitators, where things can be discussed in a protected environment without fears or hostilities. It will take multiple, sustained efforts to make core cultural changes in the behavior of patients, providers, payers and regulators. I view this as five- to 10-year effort. We want as many people as possible working on a sustained basis against the same set of principles."
The founding members of the Harvard/Kennedy School Health Care Delivery Program are Sentara Healthcare, HealthPartners, Center for Medical Consumers, The Segal Co., Stryker Corp., IBM-Global Health Industry, Aetna, Fidelity Investments, Mayo Clinic, Florida State University, CalPERS, Delta Airlines, Merck & Co., Blue Cross Blue Shield of Florida, Siemens AG Medical Solutions, and UnitedHealth Group.