About The Gazette Search Back Issues Contact Us    
The newspaper of The Johns Hopkins University March 17, 2008 | Vol. 37 No. 26
Thinking Out Loud

William R. Brody

By William R. Brody

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.


The Gazette | The Johns Hopkins University | Suite 540 | 901 S. Bond St. | Baltimore, MD 21231 | 443-287-9900 |