Wal-Mart's epiphany

So Wal-Mart is expanding health coverage to more of it's employees -- at least according to a story in today's New York Times. What caught my attention was the description of how they've shifted their view on health benefits -- what were once seen as pure costs are now seen as investments in the work force to improve "presenteeism" and absenteeism and thereby increase overall productivity.

Personally, I'd like to see us get rid of employer-sponsored health insurance, but I recognize that one positive aspect of it is that employers can instill market principles into health care delivery by acting as "smart buyers" of health care services on behalf of their employees. The fact that it's taken Wal-Mart, of all companies, this long to come to the realization that investing in one of their key factors of production just might improve productivity suggests that this "smart buyer" role may not be as compelling as we'd like to think. Maybe Wal-Mart's epiphany will accelerate this type of thinking among other employers.

Now, if we could just get Wal-Mart to invest in technology upgrades for their health care delivery supply chain, we might make better progress on the health IT front.....

Employers take the pledge

Secretary Leavitt on Thursday extracted a "pledge" from some large employers in Minnesota to push for better access to health care information for their employees. The article (Employers take on a new health challenge) reported this as follows:

Executives from 3M, Wells Fargo, Target Corp., Carlson Cos. and other Minnesota companies met with Leavitt and then signed a pledge to seek better health care information for their employees. The companies employ 3 million workers, Leavitt said, which will make them an influential force when demanding cost and quality information from health insurers and their networks of hospitals and doctors.

I'm assuming that the "pledge" is very general and doesn't specify what it means to "seek better health care information." I do think it's great to create a sense of urgency among employers and patients about the need for better health information, and this type of "pledge" seems like a great use of the Secretary's bully pulpit.

I don't know whether these employers are going to think of this pledge as mere paper, or as something that they're actually going to put some energy behind. If they do act, I hope they focus on investing in their own health care supply chains -- by thinking of creative ways to facilitate EHR adoption and local health information exchanges in their own communities, for example -- rather than on splashy but empty electronic edifices like personal health records (PHRs). Employers will get way more for their dollar by investing directly in improvement of health care delivery through greater health IT penetration, which will then make available the type of information that will ultimately make PHRs worthwhile.

I hope that these employers take their pledge to the Secretary seriously and use it as a way to coalesce around meaningful, collaborative initiatives, as they've done in Indiana (please see: Congratulations Indianapolis). It's becoming clear (to me, at least) that effective, widespread implementation and use of health IT won't happen until employers start to manage health care delivery as a supply chain issue.