WASHINGTON -- As the U.S. government continues to examine its options to improve the delivery and quality of health-care services in the United States, it should look at what some large companies are already doing as a model for what the government could do in running its own health programs, a GTE executive told a Senate panel today.
Speaking to the Roundtable on Quality Healthcare Measurement sponsored by Sens. Joseph Lieberman, Bill Frist and Jay Rockefeller here, GTE Senior Vice President Human Resources and Administration J. Randall MacDonald said that GTE and many other major companies have begun the process of measuring and evaluating the cost and quality of health-care services provided to their employees and families and are already holding the providers responsible for improving quality and lowering costs.
"Employers are aggressive and responsible purchasers of health-care services and, as such, are in the best position as clients to demand information and accountability from health plans," MacDonald said. "We encourage federal, state and local governmental agencies to contribute in their role as 'purchasers' of health-care services rather than regulators of health care. We also suggest they exercise their leverage and build upon the work of private employers to demand data, cost and quality improvements and to develop a standardized method to share information with consumers," he added.
In his presentation, MacDonald said he recognized that some managed health-care plans and individual patient relationships with plan doctors can be poor. Rather than condemning the new delivery systems that are sweeping the nation, he said GTE has chosen to become even more vigilant in the evaluation and selection of health-care providers for its employees. This approach, he said, could be used by the government to manage its own health-care provision services.
GTE Program Provides Consumer Information for Educated Choices by its Employees
MacDonald told the legislators that GTE spends more than $500 million each year on health care for its employees, and projects a similar additional cost in lost time because of health problems of employees or their families. "Developing strategies and programs to control health-care costs by actually improving employee health is a business imperative," he said.
GTE is balancing the need to manage rising health-care costs with the need to provide quality health care for its employees and their families.
"It is in our own enlightened self interest to have healthy employees at work and not away from their work sites because the health-care delivery system failed to recognize the patient's medical condition early enough or did not provide the appropriate treatment," MacDonald said.
To this end, GTE, in the early 1990s, began evaluating the health-care plans it offers and providing employees with the results to assist them in choosing providers.
"A commitment to quality health care in a cost-conscious environment requires an understanding of what defines quality and how to measure it," said MacDonald. "Only then can employers better understand a long term strategy while introducing accountability for health plans and health-care professionals."
MacDonald said GTE's concept of health-care quality encompasses the accessibility of care, the adequacy of services provided, the cost-effectiveness of the care, the patient's satisfaction and most important, the resulting health status of the patient. GTE is committed to supporting efforts to continually improve the availability of health-plan quality data, especially regarding outcomes. "Ultimately, the best data collection will enable us to determine which plans keep their members healthiest," MacDonald said.
To provide its employees with the information they need to make educated choices, GTE first insists that all plans offered by the company must have achieved external accreditation by an organization such as the National Committee on Quality Assurance (NCQA), or must be actively working toward accreditation. The company then uses data from the Health Plan Employer Data and Information Set (HEDIS), which it helped develop, to provide standardized and comparative information about each health plan to its employees. This is augmented with information from rigorous on-site reviews, employee feedback and independent satisfaction surveys.
The company then awards "Benchmark" designations to plans identified in its key market areas as the best "value" -- a combination of cost as well as quality and patient satisfaction. In addition, based on the overall information, the company gives its best providers in the country its "Exceptional Quality Designation." These are the top 10 to 15 percent that offer the highest combination of health-care quality and patient satisfaction. This information is then provided to employees in the form of report cards that allow them to selected their providers on the basis of overall value.
"At GTE, we are moving our Human Resources practices from entitlement to empowerment," said MacDonald. "Our employees want and need information to support their health-care decisions that reflect individual needs and family circumstances."
The Best Quality Costs Less
MacDonald told the legislators that GTE realized early on that employees would not want to base their decisions on cost alone. Value, the combination of cost and quality, must be the benchmark, he said.
"We have learned, during this process, that the best plans with respect to quality are among those with the lowest cost and certainly among those with the lowest rate of annual increase. We have very good evidence that the better quality plans actually cost less; that improved quality drives cost down," he said.
MacDonald concluded by stressing that GTE's evaluation processes involve a partnership with the providers. "Partnership is a process where all parties learn from each other to drive continuous improvement," he said. "GTE believes that responsible health-care reform is being driven by informed purchasers and empowered consumers who select medical services that provide high quality and value while rejecting those that do not. We all seek the best medical care available for ourselves and for our families. For GTE, best means health plans that offer the most appropriate, cost-effective treatment with measurable outcomes that our employees and shareholders can afford," he said.
GTE, with annual revenues of $20 billion in 1995, is one of the largest publicly owned telecommunications companies in the world. It is also the largest U.S.-based local telephone company and a leading cellular-service provider -- with wireline and wireless operations in markets encompassing about one third of the country's population.
Outside the United States, where GTE has operated for more than 40 years, the company serves over 6 million wireline and wireless customers. GTE is also a leader in government and defense communications systems and equipment, aircraft-passenger telecommunications, directories and telecommunications information services and systems.
NOTE TO EDITORS: A list of GTE's "Exceptional Quality Designation" providers and a background piece on GTE's employee health care programs can be obtained by calling Kathleen Lobb at 203/965-3236.