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Michael Millenson, president, Health Quality Advisors; author, Demanding Medical Excellence: Doctors and Accountability in the Information Age; adjunct associate professor of medicine, Feinberg School of Medicine.


With all the changes and proposed changes in the works, what can employers expect in the coming months?

Millenson: First, they can expect a terrible lack of clarity. There’s no question that, as Congress scrambles to make everybody happy, it’s going to get confusing. Whatever Congress passes, they won’t pass it until the spring. They are undermining first, clarifying later. It will be a very confusing time.

Second, what we do know is that responsibility¬†for all aspects of health care quality and cost will be more diffused–this means more responsibility will be placed on employers; they will need to make sure their employees don’t end up on the short end of the stick.


What advice do you have for employers?

Millenson: Keep in mind that legislation like this gets passed in a hurry, with unintended negative consequences. Stay close to the process. Pay attention.

For larger employers, make your voice heard during the political process. Things are in flux. Now is a good time to affect the process–rather than trying to deal with problems later. Even smaller employers can do this, working through organizations such as chambers of commerce.


Will the trend toward clinical integration accelerate or slow?

Millenson: Accelerate. Without question. Accelerate.

Clinical integration is being driven by forces outside of politics, forces that are pushing health care delivery to be more effective and efficient.

Even if everyone walks into the doctor’s office with a government-issued insurance card, or if there are another 20 million uninsured, the imperative for improving the care delivery system remains. We have to differentiate between the noise around insurance and the tidal wave affecting health care delivery.