The emergence of the new health care consumer - Part 1: Health Care Futures - Panel Discussion

Physician Executive,  May-June, 1998  by Robert P. Carlson

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Larkin: But there are a lot of obstacles to getting to that point.

LeTourneau: I would challenge whether you're actually measuring improving employee health status, I think you're looking at a few indirect measures, like the mammography rate which there is some evidence that it might improve employee health status, but to actually measure improvement in employee health status takes years and years. The incentive to health plans is to cut costs in the short-term and not affect employee health status in the long-term because the contracts change and switch on a yearly basis. So it's very uncommon to have five- and 10- year contracts that actually give them the opportunity to improve employee health status.

Weatherup: I don't disagree with you at all. We're nowhere near that point on many different fronts. For one, we can't measure employee health status right now, so to measure improvement in it is a huge obstacle. And as you mentioned, health status is a long-term issue, so a delivery system that had responsibility for the health status of a population would want that to be a long-term, not a short-term, responsibility.

The Physician Executive: So, how realistic is this idea as a future prospect?

Larkin: I think all of us, in order to drive the marketplace to continue to improve the quality of the products, purposely view our current managed care partners as something that may be temporary if they don't meet performance measures. But part of the sophistication we all strive to develop is that even though our association with a particular health plan vendor may be short-lived, we look for the inherent processes that would anticipate long-term benefit to the employee, because we anticipate that employee will be with us longer. To Barb's point, it is true that if you allow those health benefit plans simply to have processes that give them a short-term gain but with no long-term results, part of your demand for performance should be processes, be it disease management or something else, but that inherently will have a long-term benefit with all your future partners.

Rippen: In addition, on the whole issue of employee health status from an employer's point of view, there's a privacy and confidentiality issue as far as whether an employer has the right to know an employee's health status.

Reinhardt: There's even a Nurse Ratchett effect.

Rippen: I can't wait to hear what that is.

Reinhardt: It has to do with the idea of rewarding health plans financially for the health status of their entire population. I'm opposed to that because I think it sort of leads you down the path of a Chinese commune. For one, it leads to discrimination of whom you let in unless the instruments for [risk] adjusting are very good.

For example, if you were to evaluate me by the intellectual accomplishments of my students and peg my salary on that, I would probably start discriminating on whom I would or would not allow to enroll in my classes, And I would have certain prejudices, some of them based scientifically, some just preconceived notions about who will or who will not be a good student and act accordingly. Plus, I might intervene with students. I might see them at a party and say, 'You know, if you go out and party, my rating goes down,' and intervene. That's the Nurse Ratchett effect. You know, if she would see you eating a meringue pie, the first thing you know you get an email from your HMO scolding you. I think that idea is not a good one.