HealthLeaders: Are technological innovations making it easier? In what ways?
Steele: At Geisinger we started with Epic in 1995. At the time, we realized that decision was either very silly or very wise, but it's turned out to be wise. Starting almost 12 years ago we began this data warehouse effort. Not only on healthcare provision but also on the cost and transaction side. We spent 4.5% of our revenue per year on maintaining and improving our data warehousing capability. That's a huge amount, and we're constantly upgrading. But the fact is, we couldn't do what we do in value re-engineering without having real-time feedback. The fact that now other systems in the country have this capability gives us a scaling and generalizing capacity that wasn't available before.
HealthLeaders: Are there competitive or antitrust concerns that must be addressed in these types of collaborations?
Steele: As we do this, we have to make sure we're in the regulatory compartments that don't allow us benefit from the things that Econ 101 says is possible in terms of colluding. Secondly, one of the major compelling reasons for consolidation is to allow us to integrate in ways that are only possible in the same fiduciary. But you have to prove that you're bringing value to a population of patients—that you're not ripping them off. How we actually regulate what is becoming a consolidating payer and provider market—there will have to be a different functional metric to show they bring value to a population.