2008 Annual Report
What's on your mind?

What if my family has a health crisis? How do I know we will have access to the best physicians?

Brenda Bruns, MD Brenda Bruns, MD: We provide access to the full range of medical expertise. Our medical group is larger and has more depth than many people realize — with more than 82 specialties and subspecialties. And if you end up with some unusual need or complicated condition that we can't manage directly, we'll connect you to the right physicians, wherever they are. That's why we thoughtfully build relationships with other specialists and institutions, identifying partners that meet clinical quality standards, not just relying on word-of-mouth. And as we make referrals for you, we continue to coordinate your care. You aren't expected to manage it yourself — when you're in a health crisis, that coordination is critical to getting the best results.

Too often in a health crisis, consumers rely on friends or family for a recommendation — hardly a thorough way to find the best person to operate on your spine. Patients routinely use choice as a proxy for quality, believing that having the choice of any doctor will get them the quality they want. But it doesn't work that way.

Many people also think that the more care you get or the more it costs, the better it is. But no. In analyzing the practices of various physicians, I've found that those who are most efficient have the fewest complications. That is why there is something of a mantra at Group Health: The right care at the right time at the right place. You don't need this idea of superstar doctors. What you need is evidence-based medicine and a system that consistently delivers quality. If you talk to our doctors, they'll tell you this is why they came here.

Michael Soman, MD Michael Soman, MD: Of course every organization says their doctors are the best, so that's not very helpful. But what is helpful is this: the research that came out of Dartmouth. It's called the Dartmouth Atlas Project, and it looks at physician practices by geographic regions across America.

A physician researcher named Jack Wennberg headed up the project, and here's what he found: The main factor influencing which treatments doctors select is not what the latest evidence says is best. Turns out many doctors base their treatment choices on other things — how they learned to do it in medical school, how other MDs in their town treat the same condition, even what approach generates more profit. Maybe their treatment is five years behind the times. Maybe more. Point is, doctors all over America are treating the same conditions in wildly different ways.

Wennberg calls this "unwarranted clinical variation" — variation between doctors' approaches and what the research says is best. Not only is this dangerous, it drives up costs because unnecessary care wastes resources and often harms patients. Wennberg estimates that as much as 15 to 20 percent of today's health care costs are the result of this.

The risk of unwarranted clinical variation is one important reason you want to go to Group Health. All doctors want to do what's right, but here we're pushing beyond good intentions. It was hard to acknowledge that even we had room to improve. But we looked hard at ourselves, at our data, and not only acknowledged the opportunity but went after it. Our doctors are building an organized system of knowledge-sharing. I know only two other organizations in the country — Mayo Clinic and Intermountain — that are taking on unwarranted clinical variation in such real terms.

Doctors still need to be independent thinkers. The best ones use intuition, psychology, and encouragement along with the latest evidence and technology. But with so much new information today — there are 23,000 medical journals — even the best physicians need help to stay cutting edge. That's why our approach is so important: It marshals the collective wisdom of the medical world and makes it possible to tailor that wisdom to each patient through each encounter with their physician and clinical team.