wharton's prescription for health care - Wharton Magazine

FEATUREdoing, which is what your patients and members want youto do. Your HMO could pay for bone marrow transplants,but your premiums would be higher. What should be theprotocol for very low birthweight babies? A lot of HMOs aretrying to adopt clinical pathways or guidelines.”Kissick’s image of health care is as a “quasi-regulated marketsystem with certain checks and balances ... where healthcare institutions develop budgets, receive capitation payments,and then allocate those funds based on input from consumersas well as providers.” Pauly sees a supply and demand systemwhere health care providers such as HMOs closely monitortheir physicians and reward those who are responsive topatients. Patients for their part choose a health plan based onthe plan’s cost, the services covered and its reputation.All observers agree that whether the debate is aboutrationing or cost containment or better service, one of thegreat promises for improvement lies in information technologyand its potential for better allocating resources,measuring quality and conveying information to buyers andconsumers — ideally with the goal of using informationmore wisely to improve care as well as hold down costs.“The systems and incentives are right, provided we havegood measures of outcomes,” notes Danzon. “We still havea long way to go before we have reliable report cards [to helpus] compare plans on both outcomes and costs.“At the same time, there has been enormous growth inthis industry. It’s a very exciting development and the U.S.is leading the world.”T HE ALUMNIAccording to figures from the health care systems department,alumni of the program fall into the followingcategories: Approximately 30 percent work in health caredelivery organizations, including hospitals, managed care,long-term care and clinical practice; 21 percent in consulting;eight percent in pharmaceuticals, biotechnology firmsor equipment manufacturers; six percent in financial servicesand insurance; eight percent in educational or researchinstitutions or foundations; three percent in federal, state orlocal government, and the remainder in other health-relatedpositions.As a group, Wharton’s health care alumni graduates arean unusually cohesive and activist bunch. Two years ago,for example, 10 alumni and students spent a week in Beijingoffering quality management training to 60 administratorsfrom China’s preeminent teaching hospitals.In addition, the health care alumni make up one of onlytwo alumni clubs based on industry (rather than geography),and they sponsor numerous symposia, lectures andconferences, including October’s three-day celebration ofthe department’s 25th anniversary entitled “RedesigningOur Future.”At that event, the Robert D. Eilers Memorial Lecturer wasJohn Eisenberg, WG’76, chairman of medicine and physician-in-chiefat Georgetown University. The speaker istypically an individual who is distinguished and visible inthe field of health care. “That we have someone of that caliberin our own alumni ranks is a sign of the program’ssuccess,” says Rosoff.“We were the first and the biggest program to train physiciansin management,” notes Pauly. “Many of them wentoff to be leaders in managed care plans. And we also createda kind of fifth column in medical schools, people like JohnEisenberg who are spreading the word that physicians haveto start thinking about management issues.” ”Lisa David, WG’84: partner,APM Inc.“Everyone involved with servingpatients recognizes that we are in fora period of tumultuous change,”notes Lisa David, a partner in theconsulting firm of APM, Inc., in Manhattan.“As a consultant, there is a lotmore intensity and pressure in whatwe do, but in many respects it’s easierbecause you don’t have to sellanybody on the need for change. It’sa matter of helping them come upwith the right answer.“We are doing more to improvebasic care than we did eight yearsago,” adds David, who has beenwith APM since 1985. “The interestsof doctors, hospitals, alternativeproviders and so forth are comingtogether. So you start to get wholeanswers instead of improving thingson the margin. And for people withgood business training there are bettercareer opportunities than everbefore, including all kinds of new businessesas well as new roles in all thetraditional health care organizations.”APM works mostly for health careproviders, including hospitals, largemedical groups and institutionalprovider networks. “We are lookingfor cost efficiencies, better coordinationof services from the patients’perspectives, and the delivery ofhigher quality, more proactive care,”David says. This could mean designinga provider network’s relationshipwith managed care companies and/orhelping decide the network’s organizationalstructure. APM also looks athow hospital processes are configuredto deliver care, and analyzes informationsystems to determine appropriatetechnology use.In some respects, David says, “thedelivery structure is being redesignedby the health care providers themselves.What is not being answeredare the policy issues of who is coveredand how many standards of care wehave in this country. The current dialoguewill get worse in terms of whatwe are willing to pay for. We willhave more uninsured, and there willbe a greater discrepancy betweenwhat those with coverage will haveaccess to, and what those who don’t,won’t.”There are reasons for concernover health care, David says, “but thepotential for doing the right thing isthere ... For every company I seecoming in to make money, there isanother company that is getting paidto do it better from a patient’s perspective.A good number of managedcare companies do well because theyactually are doing a better job ofworking with the patient, not justrestricting access. There are modelsout there to follow.”11W HARTON ALUMNI MAGAZINE