Leaders from the business and public policy communities have launched a nonpartisan think tank promising fresh solutions to America's healthcare problems. The Healthcare Performance Management Institute (HPM Institute) aims to advance the study of how organizations can use management theory and technology to improve the country's healthcare system.
"The health reform legislation enacted by Congress didn't really address the cost issue. It talked about insurance reform and access but not affordability," said George Pantos, Executive Director of the HPM Institute. "The idea that technology can be applied to address this problem isn't viewed as the all-encompassing answer to the problem but it's a huge step in the right direction to try to bring costs under control."
The HPM Institute is the brainchild of several leading private-sector companies, including Lockheed Martin, that are developing technologies to allow executives to manage their healthcare resources just as they manage their sales or supply chain operations.
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"Generally you go to an insurance carrier, sign a contract for a policy, and make that known to your employees. Claims are filed and then, at the end of the year, you get a letter from the insurance company saying you're premiums are going up. That isn't a situation in which the employer has much control. He is just at the other end of the contract," Pantos said.
He noted that employers with access to their plan's claims data such as self-insured organizations can spot problems early, in aggregate, and provide appropriate health services to workers. In the same way that information guides management decisions elsewhere in the company, insurance data such as prescription drug trends, can provide an early indicator of health needs.
"This whole health performance management approach is a corporate discipline, a management discipline applied elsewhere in the company. The idea is to use health plan claims data as a great indicator of what is happening in the plan."
Since drug benefits information is reported immediately, that's the best data to mine for trends, as opposed to insurance claims for office visits and procedures that take months to process.
"Because of real time technology, software and computers, it's possible to access this prescription data within 24 hours of it being filled in the drug store," Pantos said. "We are trying to use technology to identify risk, before the illness kicks in; then the actionable strategy is to engage that individual with health coaches and health behavior changes that can reduce the likelihood of expensive catastrophic conditions."