Facing impending congressional action on health care reform and an increasing clutter of managed care and wellness benefit offerings, employers find themselves caught between a rock and hard place. Medical costs have continued to rise, in spite of decades of cost controls and managed care programs.

Instead of trying to squeeze more dollars from doctors and hospitals, employers have a better option: realizing significant cost savings and improved employee satisfaction and treatment outcomes by helping employees and their doctors make the right decisions about care.

Some experts believe that as much as 30% of our country's health care expenses are devoted to the problems caused by misguided medical decision-making, a problem that ironically has been worsened by the well-intentioned efforts of managed care.

The real-life experiences that employees encounter underscore the importance of fixing this problem. Consider the case of "Mary," an employee of a large company in the Midwest.

Mary found a small lump in her breast and was seen by her primary care doctor, who quickly referred her for a series of tests. The diagnosis was cancer in one breast and several lesions in the other breast that did not meet the criteria for cancer.

Mary's doctors explained that the current evidence-based approach was surgery to remove the cancer in the one breast, while taking a watchful-waiting approach on the other. However, she read on the Internet that, in some cases, it was best to be more aggressive and do a bilateral mastectomy.
She showed the articles to her doctors, who assured her she did not have to worry. Her case was straightforward, they told her, thanks to early detection and intervention. Eighteen months later, she was dead of metastatic breast cancer.

It turned out that Mary's cancer was more aggressive than anyone suspected. By the time of her follow-up mammogram months later, there were a number of tumors in both breasts, and cancer cells had spread to other parts of her body. Her doctors finally performed a double mastectomy and a series of different treatments over the next year, but to no avail.

The insurer played the odds on Mary's case. In some cases like hers, it is better to delay surgery as long as possible. But Mary's insurer paid for both the invasive treatment and the cost of an advanced disease that could have been avoided by doing the right thing from the beginning. The protocols of treatment encouraged by managed care often discourage doctors from doing more investigational work, and the time constraints doctors face every day reduce the odds of full clinical deliberation.

Point-of-care medical decisions like these are the greatest drivers of employer health care costs. It is the cancer patient trying to decide on the right course of treatment; the mother trying to decide how best to treat her baby born with a heart defect; the patient who has seen four doctors and can't decide between four opinions.

Recent research on treatment plans has shown that initial diagnosis and treatment decisions were either incorrect or inadequately supported in more than two-thirds of cases. Almost one-third of the cases featured insufficient workups, where additional testing was needed in order to make sound clinical judgments.

As a result, more than 20% of the cases had incorrect diagnoses, and more than 60% had incorrect treatment plans. Nearly half of patients reported that they felt something was going wrong in their care, and they weren't sure where to turn for help.

Employees' acute care decisions immediately affect their lives and the bottom lines of the businesses that pay for their care. Employers that can help their workers get the right diagnosis and treatment early will provide a concrete health benefit that saves money on medical costs, drives high levels of employee satisfaction and improves the quality of care.

In the current health care reform debate, the value of clinical accuracy for both patients and employers deserves greater consideration.