Healthcare industry outlook.

• Position: Panel Discussion

When it comes to your health, there's no sidestepping the important issues of funding, technology and physician capability. Doctors, insurance providers and executive-level representatives from the healthcare industry gathered recently with Utah Business magazine in the downtown Ernst & Young boardroom to discuss issues ranging from the ramifications of baby boomers' retirement to rising healthcare costs to providing care for unfunded patients.

Attendees at Utah Business magazine's fourth Industry Outlook round table discussion included Michael Bahr, Altius Health Plan; Steve Bateman, Utah Hospitals & Health Systems Association; Phil Bryson, Blue Cross/Blue Shield of Utah; Dave Gessel, Utah Hospitals and Health Systems Association; John Hanshaw, St. Marks Hospital; Annette Herman, United Health Care of Utah; Bob Immitt, Cigna Health Care; Ken Johnson, Weber State University; Neil Kochenour, University of Utah Hospitals & Clinics; Suzette Musgrove, Dental Select; Greg Poulsen, Intermountain Health Care; Michael Stapley, Deseret Mutual Benefit Administrators; and Scott Williams, Utah Department of Health. Special thanks to Rick Pullmer of the University of Utah Hospitals & Clinics for acting as moderator.

This gathering allowed those in the healthcare industry to discuss important issues. Their conversation also provides an opportunity for those of us concerned about our own health to better understand those issues and what is being done on our behalf. As Neil Kochenour of the University of Utah pointed out, "We all have the same interests at heart. We just need to get together so that we all understand what's going on and get united.

How can a business owner or an HR manager who is buying a healthcare plan for employees know that he is getting exemplary service and insuring quality patient outcomes? What are the characteristics of quality, how do we measure quality, and how do we relate that concept to the employers and the employees who are paying for most of the healthcare that is provided?

BAHR: Most employers don't view quality in terms of medical outcome. And so from an employer's perspective, they view choice and a lack of complaint. Now what another agency would want to do is figure out how to measure quality from outcome perspective and market that, but if you look at the market today, that's not what they view quality as.

IMMITT: The industry is doing a better job. There are two components of HEDIS (Health Employer Data and Information Set). One is effectiveness of care measures, and the other is customer satisfaction. And those surveys are being done on an annual basis now. The state mandates that all health plans do HEDIS. They're reported publicly by the State Department of Health, and looking at that as an indicator, I don't think it's at a point now where it might be a good buying guide, but it's getting better, and health plans are complying, and we all have action plans to improve our immunization rates.

KOCHENOUR: On the national scene, there's a group of purchasers of healthcare who have formed a consortium called the Leap Frog Group, who are looking at more infrastructure measures of the way people deliver healthcare, and some on outcomes which primarily are volume driven. They've taken some high-risk procedures, primarily cardiovascular, and looking at healthcare delivery systems, they've made the correlation that in some high-risk procedures, quality is driven by volume, and so they are asking for a certain volume of these high-risk procedures. They are looking at electronic medical records as a way to improve the quality of care.

STAPLEY: There is one additional database produced by the Department of Health under the auspices of the State Data Committee, and that's an original survey that is published and available. That's more of a satisfaction sort of thing, but it provides some information in terms of relative satisfaction with respect to health plans in the state of Utah.

BRYSON: From an insurer's viewpoint, we would like to encourage physicians to use state-of-the-art medicine where it is possible, and, in some cases, you have to eliminate practitioners who don't practice state-of-the-art medicine. They also, on the other side of the question, try to walk a fine line between what is outlawed garden medicine and not-too-smart...