The participants in an initial meeting to plan this project provided valuable direction and stimulating ideas for committee investigation. The meeting was chaired by Stanley B. Jones and included Rhoda Abrahms, U.S. Department of Health and Human Services; Robert A. Berenson; John M. Burns, Honeywell, Inc.; E. Langdon Burwell, Falmouth Medical Associates; John W. Bussman, Oregon Health Sciences University; Priscilla Dasse, Beth Israel Hospital; John T. Dunlop, Harvard University; Paul Gertman, Health Data Institute; Nathan Hershey, University of Pittsburgh; William Hoffman, United Auto Workers; John K. Iglehart, Health Affairs; Karen Ignani, American Federation of Labor and Congress of Industrial Organizations (AFL-CIO); Arnold Milstein, National Medical Audit; David Ottensmeyer, Equicor; Robert Patricelli, ValuCare, Inc.; Mindy Pellissier, Scripps Clinic and Research Foundation; Gail J. Povar, George Washington University School of Medicine; David Rosenbloom, Health Data Institute; Richard S. Sharpe, John A. Hartford Foundation; David N. Sundwall, U.S. Department of Health and Human Services, and Jeffrey Weiner, U.S. HealthCare.
In June 1988 the committee heard much helpful testimony from a range of medical, consumer, purchaser, insurer, and other organizations. A brief summary of that meeting and a list of the participants are included in Appendix D of the report.
The committee cannot identify the 12 organizations that it visited; it agreed to keep that information confidential. Many individuals from those organizations spent considerable time answering questions, showing their
facilities, reviewing summaries of the visits, and generally responding to follow-up inquiries. Several committee members were involved in the site visits: Alice G. Gosfield, Robert A. Berenson, John M. Burns, John M. Eisenberg, Nathan Hershey, Carol Ann Lockhart, Cynthia L. Polich, and Bruce S. Wolff.
The authors of three commissioned papers also contributed to the committee's understanding of issues. Two papers are published in Appendixes A and B of the report. One other paper, which is not included but is available from the committee upon request, also provided useful background information in an area that was not dealt with explicitly by the committee. This paper on Medicaid cost-containment strategies was prepared by Robert E. Hurley, Pennsylvania State University, and Deborah Anne Freund, a member of the committee. During regular meetings, the committee heard presentations on utilization management from several individuals: Ed Zalta, CaPP Care; Paul Gertman, ClinMan, Inc.; and Marcia Gold, Group Health Association of America.
Several committee members drafted materials to assist in developing the report. Neil Hollander reviewed problems with evaluating the savings claimed for utilization management programs. Nathan Hershey developed an analysis of the contents of contracts between utilization management organizations and their clients. Alice G. Gosfield prepared a background paper on utilization management in peer review organizations, and Michael Herbert provided background discussion on utilization management in health maintenance organizations. Suggestions about what purchasers should look for in utilization management organizations were contributed by Robert Patricelli, Karen Ignani, Michael E. Herbert, Alice G. Gosfield, John M. Burns, and Howard L. Bailit. Alan R. Nelson discussed physician concerns and responsibilities.
For the first year of the project, Richard H. Egdahl chaired the committee. Dr. Egdahl has since continued to serve as a member of the committee and kindly extended invitations to committee staff to attend meetings organized for Pew Foundation Corporate Fellows at Boston University. During the second year, Jerome H. Grossman chaired the committee as it developed its conclusions, outlined the report, and planned next steps.
The initial idea for this project came from Bradford H. Gray, who secured much of its funding, organized the planning session, and served as study director through December 1988. The project would not have existed without his initiative. When Dr. Gray left for Yale University, Marilyn J. Field joined the project as the committee defined its views, and she took major responsibility for drafting the report. Dr. Field will continue as study director for further work by the committee. Margaret Walkover was research associate for the early months of the project. Susan E. Sherman, who served as research associate during the summer of 1987, went on all the
site visits, and assisted in preparing the site visit summaries. Eileen Connor of Boston University contributed much to the project as a consultant, and Sharon Rosen of the New England Medical Center assisted Dr. Grossman and the committee during its final months.
As project secretary, Don Tiller provided much needed continuity as well as exemplary support for the committee. The ongoing guidance of Karl D. Yordy, director of the Division of Health Care Services, was important for the project, particularly given the changes in committee and staff leadership.
A great many people helped the committee with information and insights about utilization management. Particularly useful was a meeting in January 1989, arranged by Marion Ein Lewin of the IOM, with executives from clients of review organizations: H. Dean Belk, ALCOA; Jo Anne Brown, Service Employees International Union; Jerry Clark, UMWA Health and Retirement Fund; Richard Ekstrom, Westinghouse; Jeanne Kardos, Southern New England Telephone; Walter B. Maher, Chrysler; William J. Schneider, J.P. Morgan; Elizabeth Solem, 3-M Company; Julia Smith, Bank of America; and Loring Wood, NYNEX. Others include Harris Allen, Richard Bondi, and Constance Winslow (Aetna Life and Casualty); Mark Chassin, Jacqueline Kosecoff, and Leslie Michaelson (Value Health Sciences, Inc.); Michael Cologero, Robert Snyder, and Eileen Thomas (Blue Cross and Blue Shield Association); Jon Gable, Al Minor, and Thomas Muscow (Health Insurance Association of America); David Bergohlz and Mary Ann Sevick (Pittsburgh Program for Affordable Health Care); Mary Henderson (Brandeis University); Gail Beiber (American Medical Association); Howard Birnbaum, Deborah Kottler, and Len Vernick (Health Data Institute); John Blum (Loyola University, Chicago); Joan Trauner (coopers & Lybrand); Robert Beale and Richard Wright (Caterpillar, Inc.); Jill Bernstein (Physician Payment Review Commission); Shan Haley (American Hospital Association); JoAnne Brown (Service Employees International Union); Ronald Hurst (Association of Preferred Provider Organizations); Joseph Restuccia (Boston University), Shelley Greenfield (New England Medical Center); Steven Sieverts (Blue Cross and Blue Shield of the National Capital Area); Deborah Chollet (Employee Benefits Research Institute); and Spencer Vibbert (McGraw-Hill). The library staff of several organizations provided information or sources on a number of issues: American Hospital Association, American Medical Association, Blue Cross and Blue Shield Association, Health Insurance Association of America, and Group Health Association of America.