Consumer-driven health plans (CDHPs) have moved beyond the concept stage and are now health benefit options available to employees in many large companies. Mainstream insurers, such as Aetna, United Health Group, and Wellpoint have introduced their own CDHPs to compete with products offered by start-up companies such as Definity, Luminos, and others. Health policy analysts have expressed concerns that CDHPs could create adverse selection problems and have unintended impacts on service use. These concerns are motivated by analyses of plan designs and philosophical beliefs, but have been largely uninformed by empirical research. In this research project, we used a claims dataset to compare the medical service use and expenditures of employees who were enrolled in a CDHP in 2001 and 2002 to employees enrolled in a health maintenance organization (HMO) and a preferred provider organization (PPO). Our analysis addressed the following questions:

1. What was the impact of the CDHP on payments to providers (i.e., total expenses)?

2. What was the impact of the CDHP on employee out-of-pocket expenses for medical care?

3. Was service use different for CDHP enrollees compared with enrollees in the other health plans?

4. Was the illness burden different in the CDHP versus other plans, and how did it change over time?

5. Were the CDHP effects different in the first year of enrollment, compared with the second year?

Consumer-driven plans differ from traditional insurance and managed care products in philosophy and design. Philosophically, they seek to involve the consumer more directly in health care decision making. Typically, in these products, a “health spending account” is created from which the employee purchases services. Some form of major medical or “wrap-around” coverage is also a key part of the benefits design. If an employee spends all of the dollars in the health spending account in a given year, she then spends her own money until the deductible requirement in the major medical coverage is met. Expenditures in excess of the deductible are covered by the major medical plan. The benefit design can be tailored to cover all or part of these “excess” expenditures. To facilitate informed decision making, the employee is provided with information about health care providers, including physician education and experience, prices, and quality ratings. Usually, this information is available on the Internet to ensure easy access and promote its use (Christianson, Parente, and Taylor 2002).

Consumer-driven health plans are often compared to medical savings accounts (MSA). MSAs first became available in the mid-1980s; they were later regulated by the 1996 Health Insurance Portability and Accountability Act (HIPAA) as a tax-exempt health insurance product offered primarily to employers with 50 or fewer workers and individuals in Medicare (Bunce 2000). Consumer-driven health plans differ from MSAs in several important ways. Most CDHPs are Internet-enabled health plans that were originally financed by venture capitalists during the dot.com boom of the late 1990s (Christianson, Parente, and Taylor 2002). The use of information technology in an effort to create “informed consumers” is a distinguishing CDHP feature (Lutz and Henkind 2000; Wiggins and Emery 2001). In contrast, MSAs typically instruct subscribers to “shoe-box” their medical bills for later reimbursement from their accounts, as long as they are under the deductible. For many CDHPs, the Internet has an interactive customer support system to allow a subscriber to track medical expenditures deducted from her account online. Consumer-driven health plans offer online linkages to prescription drug benefit programs as well as online benefit eligibility information to ensure prompt payment to medical providers. Because CDHPs are much more sophisticated in their product delivery to consumers and employers, they are attractive to many medium-to-large employers. In contrast, HIPAA-regulated MSAs contain a number of restrictive provisions that can make these plans difficult to describe to consumers and intimidating for health benefits managers and insurance brokers.

Interviews with employees and CDHP managers suggest several reasons why larger employers are attracted to CDHPs (Christianson, Parente, and Taylor 2002). Philosophically, these employers want informed employee decisions to “drive the market.” Under the CDHP spending account approach, employers believe their employees have an incentive to seek information on providers’ prices and to carefully consider their need for services, because any unexpended funds “roll-over” into next year’s account balance (Parrish 2001). This potentially reduces the annual “gap” between the spending account contribution and the deductible amount faced by the employee. Also, employers see CDHPs as possibly reducing their administrative expenses. If the CDHP is popular with employees, it may mean that other plan options can be dropped. Finally, some employers may see the CDHP approach as a way to divorce the amount their contribution to health insurance increases each year from trends in premiums, linking it instead to overall employee compensation increases. In this respect, CDHPs would function as “transition vehicles” that could be used to redefine the role of employers in the purchase of health insurance, much as defined contribution retirement accounts did with respect to retirement benefits (Trude and Ginsburg 2000).

Rationale: Critical illness polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented critical illness polyneuropathy in a surgical intensive care unit.

Objectives: To investigate the impact of intensive insulin therapy on polyneuropathy/myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days.

Methods: This was a prospectively planned subanalysis of a randomized controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in critically ill medical patients. All patients who were still in intensive care on Day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on critical illness polyneuropathy/myopathy and the relationship with duration of mechanical ventilation were assessed.

Measurements and Main Results: Independent of risk factors, intensive insulin therapy reduced incidence of critical illness polyneuropathy/myopathy (107/212 [50.5%] to 81/208 [38.9%], p = 0.02). Treatment with prolonged (? 14 d) mechanical ventilation was reduced from 99 of 212 (46.7%) to 72 of 208 (34.6%) (p = 0.01). This was statistically only partially explained by prevention of critical illness polyneuropathy/myopathy.

Conclusion: In a subset of medical patients in the intensive care unit for at least 7 days, enrolled in a randomized controlled trial of intensive insulin therapy, those assigned to intensive insulin therapy had a reduced incidence of critical illness polyneuropathy/myopathy and were treated with prolonged mechanical ventilation less frequently.

Keywords: polyneuropathy; blood glucose; myopathy

Critical illness polyneuropathy (CIP) is a primary axonal motor and sensory neural disease that occurs in critically ill patients, predominantly in those with sepsis and multiple organ failure. The reported incidence of CIP in this group is 70 to 82% (1, 2). CIP complicates patient recovery due to varying degrees of limb weakness (3-5) and may also cause weaning difficulties due to phrenic nerve involvement (1, 4-8). CIP lengthens hospital stay (7), and mortality rates in these patients are increased more than seven times (9). In these patients, a coexistent primary muscle disease is often present, termed “critical illness myopathy” (CIM) (5, 8, 10).

Several risk factors for this disease have been identified, such as the use of corticosteroids (11), neuromuscular blocking agents (9, 12-14), vasopressors (15, 16), or aminoglycosides (17-19), organ failure (20), and parenteral nutrition (9), renal replacement therapy (9), and duration of intensive care unit (ICU) stay (15). Until recently, the only possible way to affect the incidence of CIP or CIM was to reduce the risk factors (8). However, strict glycemic control in a surgical ICU substantially reduced the incidence of CIP in the subset of patients who stayed in the ICU for at least 7 days. This was accompanied by a lower incidence of prolonged mechanical ventilation (15). In the current study, we examine the effect of the same therapeutic intervention in a medical ICU population, which, by the nature of the diseases for which ICU admission is required, has a greater exposure to the known risk factors for CIP and CIM as compared with surgical patients.

Some of the results in this article have been presented as an abstract (21).

METHODS

This study is a prospectively planned subanalysis of a randomized controlled trial (n = 1,200) of medical ICU patients allocated to either intensive or conventional insulin therapy (Figure 1). Intensive insulin therapy (IIT) was aimed at blood glucose levels of between 80 and 110 mg/dl. The conventional insulin therapy (CIT) approach required insulin only when blood glucose rose above 215 mg/dl and tapering or stopping insulin when blood glucose fell below 180 mg/dl. Details of the entire patient population have been described elsewhere (22). Details on measurement of blood glucose, ventilation, weaning, and feeding strategies are given in the online supplement.

Here, we assessed the impact of IIT on CIP and/or CIM (CIP/CIM), and duration of mechanical ventilation, and compared the incidence of CIP/CIM and its risk factors between medical and surgical patients in the ICU for at least 7 days.

Diagnosis of CIP/CIM

The diagnosis of CIP was made using electroneuromyography (ENMG) (4, 23, 24). Differentiation between CIP and CIM based on electrophysiologic data without muscle biopsy is only possible in cooperative patients or in those with strictly sensory CIP (4, 5, 8, 24). At this time, there is no evidence that differentiating between neuropathy and myopathy has any impact on patients’ prognosis (4, 24). Therefore, we will use the term “critical illness polyneuropathy/myopathy” (CIP/CIM) in this study. Further details on the diagnosis of CIP/CIM are given in the online supplement.

Between 1992-93 and 2003, the percentage of private sector workers participating in employer-provided medical care plans steadily declined. Medical care covered 63 percent of workers in 1992-93, compared with 45 percent in 2003. (1) There were less dramatic declines in retirement plan coverage; such plans covered 53 percent of workers in 1992-93, compared with 49 percent in 2003. These declines may be the result of shifts in the composition of the labor force, changes in employer decisions to offer coverage or employee decisions to choose coverage, or some combination of these and other factors. Using data from the Bureau of Labor Statistics National Compensation Survey, this analysis begins to quantify how some of these factors affect the overall decline in benefits coverage. This is just a first step, however; further analysis planned by BLS is identified at the end of this article.

Medical care coverage declined for various populations within private industry. Among full-time workers, there was a 17-percentage point decline in medical care coverage over the decade, from 73 percent in 1993-94 to 56 percent in 2003. Part-time workers rarely have medical care coverage, thus there was little change in the percent of part-time workers covered.

While overall retirement plan coverage declined only slightly over the decade, there was a continuation of the widely reported shift from defined benefit to defined contribution plans. (2) The percent of workers covered by defined benefit plans shows a clear decline–coverage among private industry workers declined by more than one-third over the decade. While such plans are more prevalent among larger employers, coverage has declined in both larger and smaller establishments. At the same time, there have been increases in defined contribution coverage. The net result has been a slight decline in the percent of workers with any retirement coverage as well as a slight decline in those covered by both a defined benefit and a defined contribution plan. The introduction of 401(k) plans in the 1980s led to a period of dual defined benefit and defined contribution plan coverage for many employees. (3) The decline in defined benefit coverage is having the effect of slowly eliminating the occurrence of dual coverage.

Much has been written on trends in employee benefit coverage, and on the data sources that are available to track these trends. Diane Herz, Joseph Meisenheimer, and Harriet Weinstein discuss the two basic sources of data used to measure benefits coverage–data from households and data from employers. (4) Data from households have the advantage of providing good detail on demographics, family income (beyond that from a single employer), and alternative sources of benefit coverage (such as spouse coverage for medical care). Data from employers provide more precise information on the type of plan and details on how the plan works. John Turner, Leslie Muller, and Satyendra Verma look further into definitions of plan participation for defined contribution plans. (5) This work considers a number of variables in arriving at plan participation numbers, including employer sponsorship, job coverage, eligibility, and current contributions. The authors provide a comprehensive analysis of the many alternative questions that need to be considered in counting covered workers. Beth Levin Crimmel analyzes data from the Medical Expenditure Panel Survey-Insurance Component on employer medical care offerings in 2001. (6) Finally, the Employee Benefit Research Institute regularly analyzes the latest benefits coverage data, and has conducted several recent examinations of alternative sources of benefits data. (7) Each of these sources provides background information on the many details involved in tracking benefits coverage.

Causes of declining benefits coverage

Changes in benefit coverage can be the result of many different factors:

* Legal changes, such as the introduction of 401(k) plans, can change the benefit packages available to employees or change the advantages employees can receive from those benefits. Changes in the law can prompt employers to offer plans or discourage them from doing so. Likewise, employees may change their decision to participate in a plan based on legal changes. For example, if a law or regulation change made it more difficult for employees to get access to funds in a defined contribution plan, they might be less inclined to participate in the plan.

* Employment may shift toward industries, occupations, or other segments of the economy that tend to have particular types of benefits. For example, BLS employment data indicate a decline in the proportion of workers in goods-producing industries over the last decade. (8) To the extent that employers in these industries offer certain benefits more often than do employers in other industries, the shift in employment could affect overall benefit coverage.

Past research suggests that the negative consequences related to exposure to traumatic events and injury may impact cohesive work relationships. Additionally, trauma and low cohesive relationships independently predict poorer psychological and physical health in service members. The objective of the present study was to examine the interrelationships between exposure to traumatic events, burnout, and cohesion among tri-service medical and support staff. Surveys were administered to 253 U.S. Army, Army Reserve Units, U.S. Air Force, and U.S. Navy personnel upon arrival in Hawaii for participation in a stressful, 2-week training exercise. Results showed that history of trauma was correlated with poorer view of officers and higher levels on two components of burnout. We discuss how findings can apply to prevention and early intervention efforts.

The U.S. military is composed of a variety of units, large and small, that must quickly adapt to perform widely varying missions. Across missions, the success of each group often depends on a cohesive effort among individuals. Typically, individual service members are required to form group alliances quickly and work together effectively. Most individuals are able to form cohesive group bonds with peers and effective relationships with their leaders. These individuals are perceived as helpful to the group effort and tend to be rewarded. However, individuals who have problems working in group settings are often disregarded by peers and superiors. Poor cohesion tends to perpetuate poor performance and ultimately can lead to career advancement difficulty.

Regardless of institution, positive interpersonal relationships are fundamental in achieving organizational goals.1 Several lines of research have indicated that the extent to which group members feel a part of a group and desire to remain in the group predicts stronger performance at the group level.1-5 Additionally, group cohesion is consistently related to perceptions of job satisfaction, a sense of well-being, and lower levels of disciplinary problems.6 Therefore, there is a need to identify factors that correlate with group cohesion and those that may predict which individuals will be most capable of forming cohesive bonds.

Few studies have examined the impact that traumatic stress exposure can have upon group cohesion. However, there is reason to believe that trauma might impair work-related relationships. Among the widely varying correlates of trauma exposure, sequelae may include emotional numbing and chronic anger,7,8 a belief that the world is a malevolent place,9 and impaired interpersonal relationships.10-12 A study of 1,365 U.S. Army soldiers13 showed that soldiers who were sexually and physically/emotionally maltreated as children reported poorer perception of officers, noncommissioned officers (NCOs), and their peers. This group14 also showed that report of trauma and unit cohesion independently predicted poorer psychological and physical health among soldiers. Overall, these findings provide reason to believe that the negative consequences related to trauma may impact cohesive work relationships.

Attachment theory has been used to explain the sequelae of trauma. Attachment refers to one’s set of expectations about relationships, based on expectations developed from previous experiences with relationships.15 When previous relationships are warm and responsive to an individual’s needs, the individual will develop a “secure” attachment style. In secure attachments, future relationships are expected to provide warmth and responsivity, and the individual sees others as trustworthy. When previous relationships are not responsive to the individual’s needs, the individual will develop an “insecure” attachment style. Such an individual tends to see others as untrustworthy, nonresponsive, and in some cases, abusive.

A traumatic experience can have a major impact on attachment ability.12 Insecure adult attachment style is more likely in those who have trauma histories and post-traumatic stress disorder (PTSD) symptoms, including combat veterans and prisoners of war.16-18 McFarlane and Bookless12 propose that interpersonal trauma can become embedded in the memory structure of an individual, leading him/her to avoid other people. Because secure attachment ability is a necessary foundation for healthy interpersonal relationships, trauma exposure may lead individuals to become distrustful of others and avoid social interactions. Moreover, social situations may become associated with the trauma, thus serving as a trigger for intrusive memories of the event and other trauma symptoms. When traumatic events are work related, such events may also lead individuals to feel betrayed by the “system” that they expected to protect them. Such an impact would then likely impact cohesion with peers and leaders.

A second work-related factor that may be impacted by trauma is burnout. Burnout is a particular form of occupational stress that refers to how poorly a person is coping, reflecting both the cumulative amount of job stress a person can handle and the effectiveness of his or her coping style.19 Drawing from extant quantitative and qualitative research, Maslach20 proposed that the burnout construct consists of three separate but interrelated dimensions: emotional exhaustion, depersonalization, and personal accomplishment. The first factor, emotional exhaustion, refers to the depletion or draining of physical, mental, and emotional resources.21 Depersonalization refers to a lack of enthusiasm for one’s work and cynicism that one’s work does not contribute to a meaningful goal.20 The third factor, personal accomplishment, refers to a feeling of productivity and fulfillment related to one’s work role.21 Thus, individuals who suffer burnout tend to feel ineffectual, have cynical attitudes, and have little energy to contribute to their organization.

MedTrackAlert compiles medical development news gleaned from the online press and distributes it as an electronic newsletter to a half million subscribers. The service is currently up to 36 newsletters focusing on current data on major medications for chronic conditions. The Louisville, Ky.-based service uses a core group of researchers working from their homes to gather and write digests of selected articles with Web address links to the full version.

According to MedTrackAlert co-founder Ted Smith, the site supplies information rather than medical advice, filtering out the non-relevant ads and links common to robotic Internet searches of news alerts. The free service makes money through advertising sales to primarily pharmaceutical companies. The startup hopes to grow from its seven employees as it expands its drug coverage.

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission’s initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1-2 years, Dr. Leavitt said.

The roadmap is a key part of the commission’s work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6-18 months or more. “We need to signal to the industry as to where we are going next, so it has time to respond,” he said.

The commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not. “We are not trying to create a competitive rating system,” Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don’t create requirements that will shut down the marketplace. However, Dr. Leavitt said he expects that as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability. Physicians won’t buy EHR systems until costs are lower, their own risk is lower, and the incentives are higher. However, it’s hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn’t a wave of adoption of products that aren’t interoperable.

“We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure,” Dr. Leavitt said. “The challenge is the infrastructure isn’t there yet, it’s emerging.”

U.S. medical schools need to improve tuition- and fee-setting processes to help students pay their debts, the Association of American Medical Colleges said in a study.

The median indebtedness of medical school graduates has swelled from $20,000 for both private and public schools in 1984, to almost $140,000 and $100,000 for private and public schools, respectively, last year. Income is relatively flat, according to the study by an AAMC working group

To address rising tuition and debt, the AAMC advised that medical schools offer:

* Greater predictability about the student costs of a medical education.

* Ongoing financial education for students.
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* More financial aid, with an emphasis on need-based scholarships, loan repayment plans, and forgiveness in exchange for military service or to underserved groups.

* Periodic self-reviews of attendance costs.

Schools should also reevaluate their funding of medical education and innovative methods to generate financial support for financial aid programs that would address current health care needs, the AAMC recommended.

Group visits are a fairly new approach to medical treatment. Most frequently, group visits have been used to treat a specific, chronic condition such as non-insulin-dependent diabetes. At the Sastun Center of Integrative Health Care in Mission, Kansas, we created a group medical visit program for all disease states requiring lifestyle modification.

Methods. Our group met monthly for 75 minutes. The first half of the meeting consisted of activities typical of a traditional medical visit. When patients arrived, a nurse measured vital signs and weight, including a body mass index, fat mass, and so forth. The group met around a table. After collecting signed confidentiality agreements from each patient, the physician went around the table and spent time with each patient discussing current medical problems. Unlike a typical office visit, in the group format all members listen and discuss each patient’s situation.

The second half was spent discussing a new topic. A guest speaker or another practitioner at the Sastun Center usually conducted this part of the session. Examples of discussion topics were movement for people with arthritis, yoga stretches and breathing, nutrition with a dietician, a special “dysglycemic” diet, handling holiday stress, and stress-related eating. All patients attending had 1 or more of these health problems: obesity, hypertension, type 2 diabetes, or hyperlipidemia.
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Results. Five patients attended at least 4 sessions in 6 months. Other patients attended but not consistently. All members of the study and control groups were female, though this was not intentional. A majority of patients at the Sastun Center are female, so this was not surprising. The average age was 60 years (range, 52-66) for the active group and 50 years (range, 45-60) for the control group.

Overall, participants in the group medical visits exhibited greater improvements in weight loss and in cholesterol, triglyceride, and LDL-C reductions when compared with a control group of other patients from the Sastun Center with similar demographics. The active group had an average weight loss of 10.6 pounds (4.2%) compared with 1.8 pounds (0.9%) for the control group. The total cholesterol for the active group decreased an average of 12.3 mg/dL (6%), while the control group had an average increase of 13 mg/dL (5.7%). Similarly, there was an average decrease in triglycerides of 20 mg/dL (11.2%) for the active group and an average increase of 40.8 mg/dL (27.8%) for the control group. The LDL levels for the active and control groups changed -4 mg/dL (-4.1%) and +3.4 mg/dL (-0.16%), respectively The HDL levels overall did not change for the active or control groups.

Conclusion. Though our study used very small patient numbers, it appears the patients participating in the group medical visits had greater improvement compared with similar patients not participating in the group. Group medical visits may be a successful method for helping patients who need lifestyle modifications.

Jane L. Murray, MD

Sastun Center of Integrative Health Care, Mission, Kansas

Kaia Everson, PharmD

University of Missouri-Kansas City School of Pharmacy

Corresponding author: Jane L. Murray, MD, Medical Director Sastun Center of Integrative Health Care, 5509 Foxffdge Drive, Mission, KS 66212. E-mail: JMurrayMD@SastunCenter.com.

Physician profiling can be a reliable analytic tool that uses administrative data to compare the practice patterns of providers in terms of service and resource use. Most physicians agree with the essential goals of profiling: to reduce unnecessary variation in clinical treatment and improve the quality of the care physicians provide to patients. Yet bad memories of past profiling programs may make some physicians reluctant to participate in a new profiling program.

For example, many profiling programs imposed in the past were based on unsophisticated measurements and focused on forcing behavioral changes to cut costs. In addition, some hospitals and health systems used profiling primarily to justify removing physicians from their panels.

Fortunately, a movement is under way to focus attention on profiling that works and is acceptable to physicians. The cornerstone of such programs is using profiling data to initiate creative discussions among physicians and administrators about clinical variation and positive changes that may be made to improve physicians’ clinical decision making.

A diverse group of physicians, administrators, academics, and healthcare purchasers recently gathered at a national symposium to view the preliminary results of a three-year physician profiling project (1995-98) developed by MGMA’s research arm - the Center for Research in Ambulatory Health Care Administration (CRAHCA).

The project’s goals were to:

* Construct a national database linking transaction data with practice and physician demographic information;

* Educate participating administrator/physician teams in the use of profiling; and

* Demonstrate research applications of the project’s database.

The project’s database contains practice data on 3,900 physicians in 30 specialties at 77 group practices located in Washington, Florida, Minnesota, and New York. Significantly, this database contains information about ambulatory patient encounters from a cross-section of practices across all payers and specialties within those practices.

Several key lessons emerged from the project.

Lesson 1: Practices will participate in profiling if physicians and administrators perceive a need for the information and the organization has easy access to the data. Lack of access to necessary data is a major barrier. In fact, 40 of the project’s original 144 practices were unable to complete the project because of problems with data access.

Robert Margolis, MD, CEO of HealthCare Partners, was recently named Chairman-Elect of the National Council on Quality Assurance (NCQA), the first time a physician was so honored. NCQA is a non-profit organization that acts as a watchdog for the managed care industry, with the mission to improve health care quality. Here, Dr. Margolis discusses what employers and employees can do to safeguard health; the need for integrated, coordinated patient care; the impact of pay-for-performance in health care; and the link between good long-term decisions in health and in business.

In a time of difficulty for many health care organizations, HealthCare Partners has remained fiscally stable and has consistently improved its high quality of medical care delivery. What differentiates your medical group leadership?

HealthCare Partners is physician owned and operated. We started with a small group of doctors committed to quality care, and we have continued to grow in size and thrive because we have remained committed as both physicians and managers to patient-centered care. We give coordinated care in a total team environment, with a commitment to continuous, dynamic improvement.

The cost of health care is rising for both employers and employees. What can employees and employers do to improve physical health while guarding their own fiscal stability?

They can look for medical groups that provide systems of very well-coordinated care. Coordinating care creates significant advantages for patients by delivering high-quality care efficiently, so that patients get the most for their health care dollars. When services are integrated and carefully designed across the stream of care, this thoughtfulness up front eliminates duplication of processes and inappropriate services. Both patients and their employers benefit in terms of better health and streamlined costs associated with the care.

At HealthCare Partners, we specialize in providing patient-focused care. We have created strong communications and care delivery systems that extend from the primary care provider to the specialist and to hospitalization when necessary. We know how much care management–special attention to the whole process of giving excellent care and service–can be an important factor in patient outcomes.