CS: The organization started in the 1980s as a way for local employers to share questions and solutions about the spike in health care costs. As the dialogue progressed they decided that, if they joined forces, they would have much more clout as a group than as individuals. It was formed under the Lancaster Chamber of Commerce and Industry as an affiliate. We are a non-profit coalition, largely of employers. However, we also include health care providers, hospitals, insurance companies and consultants as members – anybody with a vested interest in health care. We have 115 members, of whom about 50 percent are employers ranging from small companies with fewer than five employees to the largest employers in the county, with several thousand employees – including Alcoa, Armstrong World Industries, High Industries, and the County of Lancaster. Our hospital members include Lancaster General Hospital, Ephrata Community Hospital, Lancaster Regional Medical Center, and Heart of Lancaster Regional Medical Center. We have some individual physician practices that belong and we also are fortunate to have the Pennsylvania Medical Society as well as the Lancaster County Medical Society as members. We’re beginning to draw more regional interest because there’s no other group like ours in this area. Fourteen of our members are from outside the Lancaster area, including some from Harrisburg and York. Our goals are to identify emerging trends of health care and how they affect the community, to communicate those trends through educational efforts and to try to facilitate solutions to the challenges that arise from those trends. We work very hard to reinforce a collaborative approach among payors, providers and insurers. Our current focus is, and has always been on affordable, quality employer-sponsored health plans.

CS: We’ve worked collaboratively to arrive at creative, local solutions to global health care issues. For example, we’ve implemented projects to enhance consumer-driven health care, such as collaborations between businesses and pharmacists to help diabetic employees become more compliant in taking their medication and have a better quality of life, which in turn leads to better productivity on the job and lower expenses for insurers. This October, we adopted a Web-based system known as DocTour, where pre-surgical patients can move through a virtual surgical procedure to emulate what they’re going to actually undergo, and to review the associated risks, as well as the availability and advisability of other treatment options. The system can also provide physicians with signed documentation that the patient has read the material, therefore the patient will have better expectations of what’s involved in their upcoming surgery. Educated patients usually have better outcomes, lower costs, and there will be fewer malpractice issues because they understand more of what’s going to happen. We are the exclusive agent of this system in central Pa., and it is available to employers to offer to their employees on site, through libraries or through any computer. We have employers in Lancaster County signed on with the DocTour system and who are paying a subscriber fee which we negotiated for a one-year trial period in a pilot program. We see this as a project that has a dual potential for success – on the employer side and the physician side.

CS: At the very beginning of our organization, you had to be an employer to be a member. We came to see the value of having the medical provider perspective available to us. Since 1997, we have had medical providers on our board and have since been able to talk more openly about things in a less confrontational manner. We created a Provider Relations Committee to look at issues that were hampering the relationship between business and health care providers, because we all wanted the same thing: healthy workers and quality of care at a good price. By engaging in a dialogue we discovered that a large part of the problem between us had been employee lack of understanding of their health care coverage and employee behaviors that were causing problems in physician offices, as well as for employers. We set up a task force to come up with a solution. What we found was that patients don’t understand their health insurance, so we asked all the health insurance carriers in the county to give us their glossaries and we made one big glossary of health care terms written in easy to understand language so that, when employees changed jobs or carriers, they had all the information they needed at their disposal. That was the first step to empower our employees to become better consumers. The second thing we realized was that there was a lot of animosity because people were bringing the wrong papers and doctors’ offices were fed up because every insurer had its own particular form. We took all these forms and came up with a common health insurance template with which the employer could generate a customizable sheet for every plan that the company offered, complete with information such as copays, precertification requirements, where to send your claims, where to call. On the doctors’ side it was fantastic because they had only one form, which they could reproduce and keep a supply in the office. The third thing we did was create a brochure called Using Your Health Insurance Wisely to prevent wasted time and energy on simple things like remembering to ask for directions to the hospital, who they should call, and answers to most commonly asked questions about health insurance. All of this was a two-year project that evolved simply from asking doctors, "What seems to be the problem from your side?" The State Medical Society underwrote the first printing of our health insurance glossary and we sent it to every physician in the county, as well as to all the hospitals and ambulatory facilities for them to put in their waiting rooms.

We also sponsor panel discussions on issues we think need to be addressed. This year we had a lot of expansion of medical facilities and we wanted to understand more about why they’re there, how that’s going to benefit us, or how it’s not going to benefit us. With all the focus today on patient safety and medical errors, we weaved that into the dialogue as well. We brought Karen Feinstein from the Pittsburgh Regional Healthcare Initiative to come as the moderator to bring these questions to the fore for us and to let our hospitals know that, indeed we do understand how hard it is to practice medicine today and how much they are asked to do for the amount of money that we’re paying them.

CS: We see medical malpractice as an important trend: it was the focus of our medical malpractice task force which, after 10 months of research, released a White Paper of resolutions to the state legislature in March 2003. We set about to alert people to the hidden problems that medical malpractice causes for employers in both cost and access to care issues: duplication of services, defensive medicine, and high medical malpractice prices that doctors have to pay are just going to be passed onto us as consumers. The current situation is not very conducive to reporting medical errors. Defensive medicine is a problem: doctors are ordering tests because they’re afraid that, if they don’t do every test, they’re going to be sued. Those tests, many of them unnecessary, could be running up costs four or five times the value of direct malpractice insurance costs. Declining access to care is a problem: if the malpractice problem is not addressed, we’re going to continue to have more doctors leaving the area or limiting high-risk procedures. We have no training of juries, which can award crazy amounts of money. Frivolous lawsuits have to be addressed because, many times, the doctor carries that stain whether or not a case comes to court. Patient safety is a contributing factor to the problem because we don’t really help hospitals put in place best practices to get consistent quality outcomes. As we move more toward consumer-directed care, there’s really nothing to help them know who is a better provider, or who really has the bad history.

CS: We are calling for a three-pronged solution: litigation reform, a patient safety strategy, and insurance reform. Our medical malpractice task force’s position paper was endorsed by our local medical society. We feel that our legislators are the ones who have to help level the playing field and bring reform by limiting attorneys fees, limiting malpractice awards for noneconomic damages, and creating "medical tribunals" to hear medical malpractice cases. You’re hearing a lot in the news today about arbitration and mediation, which is basically a take on the same theme. Medical errors happen. Let us fix the causes of those errors, let us make restitution to legitimately injured parties and let’s move on. So much time is wasted because malpractice cases are stuck in the civil arena. If we can move them to an arena where you have a judge who only hears medical malpractice cases and a panel that includes physicians, attorneys and consumers – a panel of people who are routinely involved in working with malpractice cases – we believe you’re going to have more cases settled, more quickly, with more money for legitimately injured parties.

CS: We feel that hospitals have got to do more on patient safety standards, but it’s difficult because there is no uniform code in place to help hospitals get to a point to know what to do. There have to be strategies to reduce medical errors that include a nonpunitive environment to help encourage reporting and correcting medical errors. Let’s get away from punishing you and saying you did something wrong, to helping you learn why you did it, and not do it again. Act 13’s medical error reporting requirements are a step in the right direction, but the outcomes have to be monitored and changes made accordingly. We have a lot of bad consequences from well-intentioned legislation. We have to foster a culture that’s not going to punish you. I’m not sure that doctors have really bought in yet. We also have to make consumers more accountable. If you’re overeating, you’re eating all fat, you’re doing everything that you shouldn’t be doing, and then you go to the doctor and expect a miracle to occur – if that miracle does not occur with one treatment or one pill, you can’t turn around and sue that doctor for something that is your doing. We have to figure out a way, and adopt measures, for enhanced consumer accountability. Tie it to their health insurance. Tie it to what they have to pay out-of-pocket, and you’re going to have more compliance. The balance is going to have to be an encouraging environment that’s going to proactively involve the consumer, not just be an edict from on high. We also believe that Pa. should adopt a model that allows consumers to know about a physician’s malpractice history, such as a database initiative in Massachusetts called DocFinder, where consumers can get information on the physician’s credentials, certification and medical malpractice lawsuit data.

CS: The insurance cycle of underpricing to attract business, then making up by overpricing has caught up with everybody in this latest go-around. Insurers have to come to the table; we can’t just keep letting them raise prices and shifting that cost on to the business community, figuring that we’ll absorb it. We think malpractice insurers should adopt an experience rating system whereby physicians who do not have bad claims should be rewarded with lower premiums. We applaud recent efforts to create risk retention groups to provide locally controlled and funded medical malpractice insurance. These groups also attempt to improve doctor-patient relationships and to establish strict patient safety guidelines.

CS: We are encouraged that legislative remedies are under debate at the state and national level right now. Although Pa.’s recent Senate Bill 9 – for a constitutional amendment to allow caps on noneconomic damages in malpractice cases – did not pass, we think the climate is good for change and we believe that ongoing grassroots efforts are going to be needed. We make it a habit of inviting legislators to attend our board meetings and we invite them to all of our programs in which collaborative dialogue is exchanged. So, they do hear from our side and they ask for our input. We feel that, without a carefully thought-out, three-pronged approach, true long-term reform is not going to occur.

CS: I can give you an example. When we were trying to encourage recent legislation – Senate Bill 9 is one example – we sent an email to our members and said, "You really need to contact your legislators." We had more replies to our email from our 115 members than the Chamber did from its 3,000, because our members are the stakeholders in health care. We know who to go to. Can we reverse the tide alone? Probably not, but we know that our opinion is respected because legislators and others have told us and have come to us for our information and input.