First, cost may not be the most important measurement with which to compare clinical practices. Despite these drawbacks, insurers regularly use these tools in attempts to change physician behavior. Physicians are also deluged by practice guidelines. Unfortunately, the paucity of outcome data has allowed managed care organizations to create widely varied guidelines for the same clinical situations. Thus, physicians are left in the unenviable position of having to treat patients with the same clinical presentation differently, solely on the basis of who insures the patient.
Employers are also interested in cost issues.
However, unlike insurers, whose predominant goal is to pay the lowest price, employers have a more complicated role in the delivery system. In addition to needing a motivated, healthy workforce, employers see health insurance as a benefit that helps them recruit and retain valuable employees. Businesses are therefore interested in having an effective, well-managed health system for their employees. Furthermore, businesses are often well schooled in continuous quality improvement, a major component of which is reducing variation. In addition to concerns about cost, this variability raises several fundamental questions for employers.