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Integrated benefits: Who has the key to the health care data warehouse?

Pretend your employer has access to a huge warehouse of health care data. It stores terabytes of medical information collected from employee-benefit programs. Your employer can use that information to simplify the claims process, select the best health insurance plan, provide workplace safety programs, and keep costs down.

Now imagine you're up for a big promotion with lots of added responsibility. That data warehouse also contains records of the medications you take, including the Xanax your doctor prescribes for anxiety. Could your promotion be in jeopardy if your boss finds out?

The integrated benefits bandwagon

Employers are clamoring for ways to reduce absenteeism, delay the onset of chronic illness, and get injured workers back on the job as quickly as possible.  To achieve these goals, many employers are willing to spend more money for better health care. As a result, many companies are embracing "integrated benefits" — the coordination of data from all employee-benefit programs that were previously managed separately. The data comes from your group health, disability, and workers compensation histories.

Employers interested in integrated benefits
Company size (number of employees)
Percent interested
More than 10,000 81%
5,000-10,000 66%
2,000-4,999 56%
500-1,999 47%
101-499 39%
Fewer than 100 28%
Source: Integrated Benefits Institute

In order to measure any health care program's performance, you need data — lots of it. This data is invaluable because it gives employers a complete picture of the risk carried by each employee, according to Bernard Wess Jr., former chairman and CEO of InfoMedtrics Incorporated, a health care data management firm.

"When properly stored and analyzed, this data becomes information that corporate planners can use to track trends, predict needs, control risks, and cut costs," Wess says. "In short, benefits can be managed as a strategic asset."

Many of the country's largest corporations (those with 10,000 or more employees) are jumping on the integrated benefits bandwagon, according to Dr. Thomas Parry, president of the Integrated Benefits Institute (IBI).

An IBI study finds by combining data from out-of-pocket benefit costs and productivity loss, industries can get a better sense of where to devote their efforts to improve benefits management. According to the report, which focuses on the telecommunications industry, nearly 75 cents of each dollar in this combined framework is associated with lost productivity, compared with less than 25 cents spent on group health programs.

The telecommunications industry's concern about costs and productivity is in "lockstep" with other employers in the United States, Parry says. In a poll conducted by IBI, 81 percent of the largest corporations are "actively pursuing or looking into" integrated benefits. Even smaller businesses are interested. In that same poll, nearly half of the companies with 500 to 1,999 workers say they also are integrating their benefits or looking into the possibility.

Where has all the data gone?

Where do employers keep this data? While some create and maintain their own health care databases, others prefer to outsource the job to software engineers and application service providers. Some of the largest employers spend millions to build large health care data "warehouses," which are common repositories for information from disparate locations.

HIPAA privacy regulations:

  • Allow consumers to see their medical records, request corrections, and obtain documentation of disclosures of their health information.
  • Penalize people who violate patients' privacy rights with fines or criminal charges
  • Allow some health information to be disclosed without patient consent, including data used by medical researchers, law enforcement, and banks that process health care payments and premiums
  • Require each organization covered under HIPAA to set up procedures to protect patients' privacy and designate an official to monitor that system.

For more information, visit www.hhs.gov/ocr/hipaa/

In 1998, Ford Motor Company hired InfoMedtrics and Computer Sciences Corporation, an applications service provider based in El Segundo, California, to help it create such a warehouse. The data center includes group health information on 600,000 Ford employees, retirees, and their dependents living in the United States, according to Dr. Woodrow Myers, Ford's director of health care management.

Ultimately, the warehouse will contain data from 80 managed care companies and information on more than 1 million Ford employees, retirees, and their dependents worldwide. Information is gathered from group health, workers compensation, short- and long-term disability programs, and Ford's in-plant health clinics. By regularly sifting through this data, the company can monitor health trends and costs.

The ability to spot variations in health care delivery is the main purpose of storing and analyzing all this data, according to Myers. For example, he says it's Ford's goal to have every woman over age 50 receive a mammogram once every two years. According to Myers, the health care management team knows from mining data that currently only half of the women in this category get regularly scheduled mammograms.

A state of dis-ease

While the concept of integrated health benefits and medical data warehousing makes business sense, don't expect American consumers to be wholly comfortable with the idea. Although they stand to reap the benefits of a more efficient health care delivery system, a survey shows Americans are worried about the consequences of these data systems.

In a survey sponsored by the California HealthCare Foundation, 54 percent of those polled say the shift from paper records to computer-based systems makes it more difficult to keep personal medical information confidential. In addition, 55 percent of the respondents say they worry about hackers breaking into the system, and 30 percent worry medical providers, health officials, or other authorized users might leak sensitive information.

Nervousness over privacy issues has risen sharply. This fear is compounded by the Health Insurance Portability and Accountability Act (HIPAA). One objective of HIPAA is to reduce health care costs by requiring insurers, health care providers, and health information clearinghouses to work together to simplify electronic data transactions.

Unable to come to a consensus on medical records privacy standards, Congress missed its deadline to enact laws regarding those standards. That left the Department of Health and Human Services to issue regulations. (See The HIPAA law: Your rights to health insurance portability.)

Anxiety also increased when in 2003 researchers mapped the human "genome," or the genetic makeup of a human being. According to scientists, it eventually will be possible to identify years in advance who will get sick and who will stay healthy. Experts now say employers could save millions by not hiring people whose genes indicate they are prone to illnesses.

Consumers are caught in a dilemma. They want their employers to administer and help pay for their health benefits, but they're worried about giving out their medical information. They also fear their employers will be tempted to mine this data for purposes that go beyond the scope of cost-management or health improvement programs.

"It's only natural that if I take you out to dinner, I want to know what you ate — because I'm paying the bill," says Sue Blevins, president of the Institute for Health Freedom, a nonprofit Washington, D.C., think tank. "It's a matter of ownership as well as access. He who pays the piper gets to call the tune."

Companies that are integrating benefits are very aware of the sensitivity of the information housed in their databases according to Bernard Wess Jr., former chairman and CEO of InfoMedtrics Incorporated, a health care data management firm.

"It's only natural that if I take you out to dinner, I want to know what you ate — because I'm paying the bill. It's a matter of ownership as well as access. He who pays the piper gets to call the tune."

Ford Motor Company has invested heavily in military-grade security measures to prevent abuse. The warehouse is password protected, and all the medical data is encrypted. Wess says access is limited to authorized doctors, nurses, and health care analysts, and none of Ford's human resource personnel has access to the warehouse. "The system is specifically designed to optimize the delivery of health care services, not to make personnel decisions," Wess says.

According to Myers, there is no "person identifiable" information stored in the warehouse, only coded data. Information that does identify an individual does exist in a separate Ford database, Myers says. Although it's technically possible, Myers says it would be "exceedingly unusual" to have any reason to match the two sets of information. "There would be a number of hurdles to overcome," he says, "including an external review process in order to access the information."

"Access" is the word invariably invoked in conjunction with "security" whenever proponents of electronic health services discuss medical data warehouses. Even in a perfect world where only the right people access sensitive material in the most scrupulous ways, security still does not equal privacy, according Blevins. "A person may be authorized to look at an individual's medical records," Blevins says, "but that individual may still not want that person to know he was treated for a sexually transmitted disease."

There's an interesting flip side to the security issue. If health care data warehouses are so tightly protected, how will a worker even know, let alone prove, when there's been a security breach? Blevins points out it's often difficult to document misuse of information, or that your employer has discriminated against you because of your age or gender. Blevins believes it will be even harder to prove your boss passed you over for a promotion based on your medical data.

"Health information is considered relatively safe today, not because it is secure, but because it is difficult to access."

Ford employees who want copies of their medical records are referred to their physicians, Myers says. He adds the information contained in the health care data warehouse wouldn't be useful to employees in any applicable way, because the data is so specialized. According to Myers, when a Ford employee leaves his job, his warehouse data is retained because the company performs health care studies that stretch over many years.

Under privacy regulations invoked by the U.S. Department of Health and Human Services, each organization covered under HIPAA (the Health Insurance Portability and Accountability Act) will be required to set up procedures to protect patients' privacy. Each also has to designate an official to monitor the system and notify patients about their privacy-protection practices. The regulations call for penalties, ranging from fines to criminal charges, against people who violate a patient's right to privacy.

At Ford, three teams monitor HIPAA compliancy, according to Ed Miller, a Ford spokesman. These teams are made up of health care management professionals, computer systems experts, and lawyers.

Privacy watchdog groups are warning consumers they shouldn't be lulled into a false sense of security by the protection they might believe these HIPAA regulations offer. "It's all been deception and doublespeak up to this point," Blevins says. She points to a particular section of the regulations that cites a congressional report. It notes:

"Health information is considered relatively safe today, not because it is secure, but because it is difficult to access. These standards improve access and establish strict privacy protections."

"This is a complete contradiction," Blevins says. "How does giving more people access to patients' medical information establish strict privacy protections?”

In addition to HIPAA regulations, the principles of good business, employee relations, and customer service will help safeguard the medical information stored in warehouses, according to Wess. He argues employers will either protect their data or they will wind up violating fundamental public policy.

When all is said and done, Wess adds, health care is really about the confidential relationship between an individual and his healthcare provider. "Anything that doesn't facilitate that relationship," he adds, "won't prevail."


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