While larger employers have engaged their employees in wellness initiatives and consumer-driven approaches, small employers have often lagged behind. Small businesses can, however, adopt these health benefit approaches to address their own rising health care costs.

This report is the third in a series of four. The focus of this report is on administrative efficiency.

Policymakers are considering several options for national health reform, each of which includes some form of "insurance exchange." These exchanges allow the uninsured, and employees of small to medium-sized businesses, to compare qualified health plans, purchase insurance and, if eligible, receive subsidies toward the cost of their plans.

Passed in 2006, the Massachusetts healthcare reform bill represents an innovative approach to healthcare reform in the United States. The bill (Chapter 58 of the Massachusetts Laws of 2006) has four main goals: to use an individual mandate to expand access to near universal levels; to establish guidelines for employers' fair share' contribution and involvement; to reorganize insurance markets and manage the distribution and subsidization of several insurance plans through the new Massachusetts "Connector"; and to establish transparency that will aid in understanding and assessing the bill's cost and quality of care.

The Massachusetts Group Insurance Commission (GIC) has embarked on a groundbreaking plan to control costs, improve healthcare quality, and promote cost-efficiency. Labeled the Clinical Performance Improvement (CPI) Initiative, this multi-year effort has the potential to save the Commonwealth and its enrollees tens of millions of dollars, while improving the quality of care.

Over the course of the past decade, thousands of organizations have used business process redesign and information technology to get to know their customers well, and they have used that information to do a better job of meeting their customers’ needs. Five years ago, anyone who had a checking account, a mortgage, an auto loan, and a credit card with the same financial institution might as well have been dealing with four different companies. Today, more often than not, that individual gets one statement each month that consolidates his or her entire relationship with that financial institution. The bank knows the extent of its relationship with each customer, and its customers can manage their accounts and loans in a unified, coordinated manner.