Lassoing the Locomotive
You would have to cover your eyes and ears and go into
the forest for an extended period of
time to escape hearing about rapidly rising health care
costs. The federal government reports annual
increases at about twice the rate of inflation. The number
of uninsured keeps growing. The Medicare
Trust Fund faces eventual bankruptcy. Our nation's medical
bills are like a runaway freight train that
no one can seem to stop.
It should hardly come as a surprise, then, that this
issue is creating enormous challenges for
The Johns Hopkins University and Health System, which
combined represent the largest
nongovernmental employer in the state of Maryland. Our
commitment to provide quality, affordable
health insurance to our employees is challenged daily by
increasing costs. Controlling them sometimes
feels like trying to lasso a speeding locomotive.
So what to do?
A part of the problem has to do with how health care
is billed and paid for in America. Most
working people get their health insurance through their
employer. But in this system employees often
have little understanding of what their total health care
package actually costs, and what they can do
to help hold the line on those costs. They might, for
example, be using a highly advertised name-brand
medication when an equally good generic drug is available
for a fraction of the price. Employees with
conditions that require ongoing management and care, such
as diabetes, high blood pressure, cancer or
other chronic conditions, can often benefit from
information tailored specifically to their condition--
information that can both improve their care and do so in
the most cost-efficient fashion. The bottom
line is that the healthier employees stay, and the more
effectively they use the medical services they
do need, the lower the costs for them and their
employer.
In 2006, we provided a voluntary health assessment
profile, but just 5 percent of our
employees elected to use this option. So this year, to
increase participation, we tied a portion of
employee benefit dollars to successfully completing the
survey. The reason we did this is preventive:
The computerized survey is designed to spot and
confidentially inform participants of possible medical
risks they face. It also automatically provides information
that participants can use voluntarily to
reduce their risks of incurring more significant medical
problems. Identifying risks, and, whenever
possible, preventing illness and injury, is the best
possible way to control health care spending.
As a next step, the university will soon begin
utilizing a sophisticated patient advising service
that will automatically review each employee's claims
experience for medical care and prescription
drugs to look for opportunities to provide better or more
cost-effective treatment.
Using a sophisticated computerized algorithm, the
system will automatically send a confidential
letter to any patient whose records indicate a "treatment
gap," such as prescribed medicines that
shouldn't be taken together, underuse of key drugs that
control chronic conditions, or use of
expensive name-brand pharmaceuticals when equally effective
generic drugs are available. We believe
this will be an effective way to improve the quality of
care all our employees receive by making sure
that chronic disease treatment is compliant with
well-accepted, evidence-based clinical practice
guidelines.
As with the health assessment survey, the university
does not process the information used to
give our employees specific, confidential feedback on their
medical situation, nor does the university
receive copies of these reports. An outside vendor, which
provides these services for many other
employers as well as for Johns Hopkins, is able to perform
this service only by agreeing to comply with
the Health Insurance Privacy and Portability Act laws
governing the confidentiality and security of
patients' health information.
These and other efforts share a common goal: to
improve care while helping to control costs.
We know that considerable medical expenses occur in several
key areas: from lifestyle choices (like
smoking, alcohol and drug abuse, and obesity), in
care-related noncompliance (such as failure to
consistently take prescribed medications or control
diabetic blood sugar levels) and in the misuse of
proprietary drugs and diagnostic tests (which have been
shown in some instances to needlessly drive
up the costs of care). We believe that bringing the
expertise of Johns Hopkins Medicine directly to
the patient level can help reduce costs, improve outcomes
and create a healthier, happier work force.
William R. Brody is president
of The Johns Hopkins University.
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