Bleeding Red Ink
Some years later, the team faced another challenge: Kaiser, like the rest of the managed care industry, was bleeding red ink and looking for ways to cut costs. The Southern California region balked at continuing to pay about $500,000 annually for the Eddy-Schlessinger project. Recalls Les Zendle, associate medical director for the Southern California Permanente Medical Group: "There were several people at the time who thought the project was too long-term. They said it was wonderful work but the payoff was too far in the future."
Fortunately for Eddy, Kaiser's then-newly formed Care Management Institute, devoted to the very ideals of evidence-based medicine that Eddy had been preaching for years, came to the rescue. Thanks to the backing of all-important physician champions like CMI director Paul Wallace and Jed Weissberg, the associate executive director for quality for the medical groups in all of Kaiser's seven regions, Archimedes was back on track. By 2000, Eddy and Schlessinger had translated into mathematical equations the progression of four chronic diseases that are among the most expensive for doctors to treat and patients to pay for: diabetes, asthma, coronary artery disease and congestive heart failure. The following year, in 2001, the ADA, with funding from Bristol-Myers Squibb, signed a multiyear contract to use Archimedes to develop new treatment guidelines for diabetes.
What's next? In two years, Eddy says the team hopes to make Archimedes available on the Web. Eddy plans to cover the cost of maintaining and updating the system by offering it on a pay-per-use basis to a variety of organizations like HMOs, government organizations and charities, which could, in turn, offer it to individual patients. Institutional users like health systems might pay $50,000 to $100,000 a year for broader access. Drug companies and government organizations that want help in designing trials might pay even more. "The big money is on the clinical trials side," Eddy says, and could be used to help subsidize low-cost or free access for patients and doctors.
But Eddy's longstanding disdain for the healthcare system remains his key motivator. Despite spending an average of $5,000 for healthcare for every person in the U.S., he says, the system continues to keep many from receiving quality care, such as the 40 million uninsured Americanswhile at the same time pushing others toward needlessly expensive, sometimes harmful treatments. "We've got a $1.5 trillion tank rolling down the road with its windshield fogged over," Eddy says. What Archimedes aims to do, he says, is harness the power of information to give the system " a windshield wiper." To be sure, as long as Eddy is driving reforms, change can't be far behind.
Karen Southwick is a San Francisco-based technology and health writer and a former executive editor of Forbes ASAP magazine.