Supporting steerage. (From The Editor).

The first time I encountered large-scale steerage in a meaningful way was almost 20 years ago. My then employer had jumped on the cost-savings-through-managed-care bandwagon and was offering PPOs and HMOs along with indemnity coverage.

Coincidentally, my then employer was a group benefits insurer and I was a health benefits marketing writer. The points my employer used to steer me were the same points I used in print to steer employees of our client companies.

Money and ease were important then--and corporate steerage showcased both. My eyes popped at the difference in monthly employee contributions for HMO versus indemnity coverage. Ditto when it came to coverage levels; the HMO offered me no deductibles, with many services covered at 90 percent or 100 percent.

Then, they enticed me with the assurance of no paperwork, no claim forms, no assignment of payment and no waiting for reimbursement checks. They frosted the cake with a stupendous network. My GP was a PCP and my preferred specialists were HMO specialists. Even the referral process looked painless.

The outcome was that I became a managed care advocate, eventually sampling PPO and POS plans too. I remain one today. Corporate steerage taught me what to evaluate--and like most consumers, I know how to evaluate what's important to me.

We don't write much about the Leapfrog Group in HMT, but we do steadfastly follow its activities. At a time when new organizations seem to originate weekly to address the problems of healthcare quality, medication errors, consumer decisions, and the constructive use of healthcare data, I think Leapfrog will be one that stands and flourishes in another 10 years.

The reason is that Leapfrog constitutes a superlative example of steerage in the 21st century. The stakes are higher today than when I stuck my toe in the HMO pond. Today the stakes are life and death, the latter of which can result from medication errors, insufficient ICU staffing or the wrong hospital choice for surgery.

In its wisdom, Leapfrog zeroed in on three target arenas where improvement will result in fewer medical errors, where data is collected and is collectible to measure past, present and future outcomes, and where consumer interest and understanding are likely to be high. In plain English, Leapfrog continually states that its mission is to provide consumers with information and data, and thereby to empower them to make informed healthcare choices that lead to better, safer outcomes.

In my heart of hearts, I think what ticks off more than a few people is the fact that this noble, workable initiative emanates from a collection of Fortune 500 companies--who are, after all, the real payers of healthcare expenses generated in the U.S.--rather than from healthcare providers, clinicians, educators or non-profits.

Arming consumers with information and indicators of quality healthcare, and teaching them how to compare outcomes, simply cannot be bad. I don't care who starts the ball rolling. It cannot result in a situation any worse than the Institute of Medicine's 98,000 annual deaths scenario. Any improvement in the reduction of medical errors is a plus. Even one consumer who knows more today than yesterday about how to select the best hospital for an upcoming surgery is a success.