2008 Annual Report
What's on your mind?

It's hard to know what someone like me can do to help fix the health care crisis. How can I make a difference?

Scott Armstrong Scott Armstrong: Realize that accepting a model where the incentives encourage expensive, after-you're-sick, often unnecessary care and treatment is financially unsustainable. And it's just bad medicine. Recognize that what the country has now is a fragmented, nonsystem where all the elements compete with each other. It's why nothing works well together and still costs too much. It would be hard to design something much worse.

So, my advice? Demand a system that's both good for your bottom line and works to keep as many people as healthy as possible. Use your clout to lobby government, and use your purchasing choices to keep plans from inflating your rates. Stop tolerating poor or unnecessary care; it costs you money. Provide incentives that encourage employees to get involved with health and wellness programs because that will lower costs over time. I do exactly that at Group Health. (I have to, or the extra costs would break my budget.)

Richard Magnuson Ric Magnuson: You don't have to be a health care wizard. Just consider some key facts. Delivery of health care in our country is based on approaches that have remained relatively unchanged for the past 80 years. They don't work anymore. The country has an epidemic of preventable disease yet typically doesn't pay doctors for prevention. It pays only after we get sick.

Until I came to Group Health, I'd managed private-practice, fee-for-service systems. Our job was to get people to come in for as many office visits, procedures, and tests as possible. We'd build imaging centers and then, of course, make sure they were busy all the time with patients. Keep those CAT scanners and MRIs humming because you've got to pay for them.

Group Health is different. Being here has allowed me to see how nonsensical the traditional health care model really is. As more business leaders, purchasers, and patients realize this, we need everyone to join the dialogue, help educate each other, share information with peers and colleagues, and join in the effort to create a system that works for today.

Bob O'Brien Bob O'Brien: Be a vigilant purchaser and consumer — someone who really builds in accountability for the vendors you hire, including the health plans and health care systems your employees are involved in. You need to have standards and look hard at whether those standards get met. Say, "If you want to provide health care services to this company and its employees, then we expect that you will deliver it within a price envelope of X, manage your costs within a trend of Y, give us data that show how the health of our people is improving or declining, and talk to us about the cost drivers."

Business and individual vigilance will greatly shorten the time it takes to get a health care system that is accountable and under control from a financial and quality standpoint — because the buyer is sovereign and, in the end, can make all the difference if the demands are clear and firm.