GM Wants to Tune Up Your Pratice
Lowes, Robert L., Medical Economics
The carmarker hopes to apply to medicine the lessons it
so painfully learned from its Japanese competitors.
There's a giant organization aiming to lower the cost of health care while improving quality. In Anderson, Ind., it's helping create clinics where asthma patients can learn to monitor their condition at home so they can avoid trips to the emergency room. In Detroit, it's shown the Karmanos Cancer Institute how to register patients in two minutes rather than the customary 27. And in nearby Flint, it's a major player in an effort to educate doctors about curing chronic stomach pain with an antibiotic.
We're not talking about an HMO, a government agency, or the AMA. The giant here is General Motors, better known for building cars. GM represents a growing number of businesses bent on controlling health-care costs by promoting prevention and eliminating inefficiency, community by community. "It's a move from national to local solutions," explains Mary Jane England, M.D., president of the Washington Business Group on Health, of which GM is a member.
The nation's largest corporation, with 1996 revenues of $164 billion, GM worries that high health-care outlays will dull its competitive edge. Last year, it spent $4.8 billion to care for 1.5 million employees, retirees, and family members. "That amounts to $1,200 per vehicle built in the United States," says James Cubbin, executive director of health-care initiatives at GM. "We spend less on steel." In contrast, Chrysler reports a health-care expense of roughly $700 per vehicle.
Accordingly, GM is trying to teach doctors and hospitals the same lessons in quality improvement that it painfully learned from Japanese competitors. In plant towns such as Flint and Anderson, GM and the United Auto Workers have thrown their weight behind community coalitions that address higherthan-average levels of chronic illness as well as procedures such as hysterectomies.
To Princeton health economist Uwe Reinhardt, GM's role is a stunning commentary on the state of U.S. health care. "What an embarrassment for America's doctors," says Reinhardt, "to have a car manufacturer come in and teach them how to practice medicine."
GM officials prefer to say they're merely exposing doctors to cost and quality data that will spur them to do the right thing. "However, we encounter a great deal of denial when we talk to providers," says Cubbin. "They're very slow to adopt best practices. It takes a great deal of persistenceand sometimes pounding the table-to get our point across."
By all accounts, GM has won over many doctors, who believe that the automaker wants to be a team player, not the captain. But others say that for all its quality rhetoric, GM cares more about saving money-and blames physicians for high costs. "We're the easy scapegoat," says Anderson OB/Gyn William Gist.
In turn, doctors like Gist say that if GM wants to save money, it should downsize the lavish health-care benefits enjoyed by UAW members and persuade them to stop smoking and start jogging. UAW officials respond to those arguments with the word "Bunk." It's never boring when doctors, union representatives, and GM officials sit around the table and talk health care. Look for such experiences to be more commonplace as giant companies put physician practices under a microscope.
GM has made friends among these physicians
Later this summer, up to 50 hospitals in southeast Michigan are scheduled to conduct lectures and seminars to teach their medical staffs about printed reminders called "best-buy" cards for prescription drugs. Cards for oral antibiotics, for example, show that 11 insurers prefer doctors to prescribe a generic version of cephalexin at $5 rather than brand-name versions averaging $51.
The cards were developed by OHEP, a Detroit medical-education consortium, and Wayne State University School of Medicine as part of "Save 100," a program designed to teach 10,000 area physicians how to save $100 per day. …