Several years ago, more than I can specifically recall, I was at a dinner meeting with fellow Dallas-Fort Worth Business Group on Health board members and physicians from a local physician group. We were discussing the state of healthcare and looking for ways to partner with the physician community to improve the care being delivered to our employees. This was way before the concepts that form the dialogue about improving healthcare today. One of the physicians asked “What do employers want?” Without so much as a blink of an eye, I replied, “Reduced death, reduced disability, and early return to work.” Other employer representatives at the meeting seemed to agree.
Cost was not even mentioned, but reduced cost is implicit in the outcomes of reduced death, reduced disability, and early return to work. Historically, cost was the only benchmark for employers, so it was natural that cost was the primary springboard for many in those early days. Unfortunately, it led many in the healthcare field to believe that employers only wanted reduced cost. The ultimate goal for employers is healthy employees; cost is simply an easily tangible byproduct for discussion about that pursuit.
Based on my observation as a past DFWBGH board member and employer benefits manager, this meeting was one of the rare examples of dialogue occurring between employers and the healthcare community. To be sure, there have been other attempts to create dialogue, but with limited success. This dialogue dearth led me to write in one of my missives to a group of healthcare executives “…that a veil exists between employers and the healthcare community.”
At the time, much of this dearth centered on the discussion employers wanted to have with the healthcare community about patient safety. The veil has persisted to this day and is supported by a nearsightedness exemplified by the use of the term “payer,” as in healthcare cost payer, to refer to a “health plan,” as in Cigna, Blue Cross, etc. Another example has been the use of the term “provider,” as in healthcare provider, to refer to anyone that delivers health care. It’s not a leap to ask “Where is the employer in all this?”—and I think a good case may be made that employers are the ultimate provider and payer (excluding government provided benefits).
The point I want to make is that this vocabulary supports and reinforces the view by many that employers do not have a role in shaping the business of healthcare. Presumably, the healthcare community may get information about employer perspectives from their boards of trustees or directors, but I don’t see that occurring. The relentless pursuit of investment in new infrastructure and attendant added cost of care does not seem to support that either. Now, the nation is engaged in a great transition driven by multiple new initiatives in the healthcare field and the role of employers in that transition. The recent Accountable Care Act (ACA) legislation is just one of those initiatives.
Change is in the air. From the employer perspective, this means more transparency—the veil must be lifted, and the employer tempo to lift the veil will undoubtedly be increasing. In today’s lingo, “what employers want” translates into knowledge of quality (clinical outcomes and patient satisfaction), knowledge of value (the cost of services and the return for that cost), knowledge of the appropriate venue for the most efficient delivery of services, and information a consumer (employer or employee) can use to make a rational decision about their healthcare alternatives. With that information employers and the healthcare community alike can achieve “reduced death, reduced disability, and early return to work.”
Bob Queyrouze is the former manager of compensation, benefits, health, and productivity management and an internal HR consultant at the Federal Reserve Bank of Dallas.