The Statistical Abstract of the United States: 2006 predicts total health care expenditures in the U.S. will reach $2.23 trillion by the end of 2007. Others sources estimate that employers and employees pay more than 53% of that bill through fully insured premiums, self-funded plan costs, and out-of-pocket expenses. This means that if you currently offer an employer-sponsored health plan, that you have the potential to influence how the U.S. health care system is fixed because you pay the bills.

As you may be aware, the single largest problem in the system is poor and inconsistent quality at unacceptably high costs. Although we spend more per capita on health care in the U.S. than any other country, we do not receive the highest risk-adjusted quality of care in the world. So how can you impact the quality of care?

To answer this question, we need to answer a related question. That question is this, "what is the product of health care"? If you answered "good health" you are right. The product of health care is not treatment, service, any other process, or outcome provided by the system. Plainly and simply, it is good health. A health care provider can, and should, be measured by how effectively and efficiently they return a patient to good health. This cannot be done without the patient's commitment and cooperation with doctor's orders, however.

You need to educate your health plan's members that not all health care providers are equally capable of bringing them back to good health. Individuals should seek care from providers with the highest levels of risk-adjusted outcomes for the medical condition affecting them. In today's health care market, this is easier said than done.

Although it might seem logical that the best way to identify these providers is to get a referral from friends, family, your insurance company, or in some cases your family doctor, those are not always the best alternatives. A better option might be to contact a foundation, association, or other information clearinghouse that specializes in that particular medical condition to get a list of the best practitioners in that field. Then cross reference that list of names with your health plan's provider list to find the optimal provider for your circumstances. You may have to travel farther than expected for your care, but the cost and inconvenience will be paid back in fewer complications, lower medical bills, and significantly higher patient satisfaction and health.

Small employers and their employees should urge their insurance company and health care professionals to provide quality and pricing data for all services. This information will help create an environment in which value - the highest quality health outcomes at lowest market-driven costs - is recognized and rewarded. Not only will this get employees and their families back to good health faster, it will also lower your health plan costs! Yes, higher quality health care is lower cost health care. It is not like buying a car or house where higher cost often means higher quality. Health care is unique in this regard.

The effects of these actions are not as immediate as shopping your health insurance plan, switching insurance providers, increasing your plan's out-of-pocket expenses, or increasing premium payroll contributions, but it is one of a set of real solution that if broadly adopted by small employers could help to speed the rate of transformation from our current system to a value-based system.

To discover other steps small employers can take to address out-of-control health insurance costs, visit http://www.hhs.gov/transparency/index.html to familiarize yourself with and support The Four Cornerstones of Value-driven Health Care. Then let your voice be heard. Frequently communicate to health care providers, insurance companies, insurance brokers, policy makers, and your employees that only value-oriented solutions to our system's ills will be acceptable to you as a representative of the small business community. Together small employers can be a powerful force in lowering health care costs while improving its outcomes. A mission I hope you join us in supporting.