CLEARWATER, Fla., March 31 /PRNewswire/ -- Boca Benefits Consulting Group,
Inc. was represented by its President/CEO, Robert W. Murphy (MBA, CLU, RHU,
REBC) at Harvard University's "Skills for the New World of Health Care" course
conducted earlier this month. The course was jointly sponsored by Harvard's
Medical School, School of Public Health, John F. Kennedy School of Government,
and its Division of Health Policy Research and Education. This course has been
conducted by Harvard annually since 1996 and is designed to keep those
involved with health care policy at the state-of-the-art across a broad
continuum of practical and theoretical industry subject matter.
    When asked about his reasons for participating in the Harvard course,
Murphy replied, "It was actually quite a simple decision. A few years ago
while speaking at a securities company meeting regarding emerging trends in
health care plans, I had a high degree of confidence regarding the dynamics of
the system and my ability to offer relatively accurate projections.  Recently,
however, I concluded that I needed the input of thinkers with a broader
perspective than my own before establishing a new personal conceptual
baseline. The system is clearly positioned for a major structural change. The
question is really only one of direction. My earlier resoluteness had become
weakened by a lack of any single initiative showing long-term staying power. I
knew before going to Harvard that I was leaning away from absolute
propositions that proponents of consumerism have presented to me, especially
in the last eighteen months. I was actually seeking an academic soundness to
support a new set of theses I had only partially conceptualized myself."
    Murphy indicated that the bar was set high in the course. Of the forty
domestic and international participants, the vast majority were surgeons
representing prestigious institutions from across the United States. "As a
veteran of the early managed care wars in the mid-80's, and having personally
witnessed some of the physician bitterness that came with that sea change in
delivery, I anticipated a degree of cynicism to emerge. As the only benefits
consultant in the room, and clearly the only one with insurance company
attachments, I was a little nonplussed when I contemplated the group's
makeup."
    However, Murphy quickly added, "I could not have been more profoundly
wrong." According to Murphy there were indeed some sacred cows no one wanted
gored but the discussion of those issues was minimal. The physician leaders
participating in the course indicated not only a desire to take back control
of the delivery system but also indicated a clear understanding of their
potential fiduciary responsibility to the total system itself.  The broadest
issues associated with the future environment, complete with
downwardly-decentralized, algorithmically-based, distributed-management,
medical decision making, were accepted as reality. The essence of the course
therefore emphasized the techniques required to effectively manage that new,
and highly complex, reality. The old managed care issues seemed to have been
laid to rest. Albeit, an implicit, if unstated, premise perceived by Murphy
was that, over time, physicians and institutions can wrest control of their
industry from managed care by acting in a responsible and forward thinking
manner.  To that end, the cornerstone of the physician/institution strategy
must be a fanatical dedication to the highest objective measure of
quality -- and not the definition of quality bantered about so casually in
managed care circles today. Clearly articulated by several of the Harvard
presenters, there is a newly emerging, robust, quality paradigm which goes far
beyond the efforts of today's various accrediting agencies and their
reports/scorecards. Murphy opined, "Self-policing of quality will have winners
and losers among providers. Not everyone is in a position to win when using
the objective measures that many foresee -- even those who now get passing
grades by accreditation inspectors. Providers will cull out the weaker members
of their own profession in a form of post-managed care natural selection as
they more fully realize the strength that comes via their partnership with
corporate leadership and adherence to the new quality paradigm. There will
undoubtedly be losers among providers. However, externally imposed managed
care protocols may actually become superfluous. Indeed, those protocols may
even lag new algorithmically-based measures of quality demanded by providers
themselves.  This process may have a more profound effect on the delivery of
care in America than the managed care industry has had in the last decade."
    Murphy summarized by saying, "My objective was to look into the future as
best I could on the basis of the trends articulated by the foremost experts in
the business. It strengthened my resolve that individual consumerism is a
passing phase and that the future will be dominated by quality-defined
corporate/provider partnerships that aggregate purchasing power and demand
performance levels at a heretofore unseen level. Pay for performance
approaches will remain important in the short-term future. Over the
longer-term it is more likely that they will be subsumed into a culture which
tolerates only the highest level of performance. Competitive inducements to
quality performance, such as bonuses or other forms of incremental payment,
will likely become less and less frequent as deviations from
algorithmically-based systems prove to be categorically unacceptable. As much
as I have heard talk about employers just giving a block of cash to employees
and letting supply and demand take its course, I doubt employers are prepared
to abrogate the social contract that was struck with employees from the 70's
onward -- possibly due to more practical than altruistic reasons, but true
just the same. Independent surveys seem to bear this out as well. Corporate
stewardship, not consumerism, nor the federal government, will remain the
strongest force in the non-Medicare health care system for the foreseeable
future.  There may also be a new lexicon with terms such as 'LEAPNET' or
'SIXSIGMAORG' which institutionalize the highest levels of quality into
recognizable products. For those of us who work with these organizations, it
will be an exciting time."

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