As our most recent survey found, addressing high-cost claims will be a key focus of employer health plan sponsors over the next five years – in fact, it’s at the top the list. Perhaps the most effective way to solve for cost is to address quality. While we would like to think that an employee with a serious medical issue will get the right care, at the right time, in the right setting, far too often that’s not the case.
The quality of healthcare in the US has failed to meet acceptable standards for too long. An Institute of Medicine study estimated that in 2009, about $750 billion was wasted on unnecessary services, excessive administrative costs, fraud and other inefficiencies. With momentum building in the shift from volume to value in healthcare reimbursement, Mercer is working to give employers more control over health care quality through collaboration and the results so far are promising.
Mercer’s Quality Improvement Collaborative (QIC) brings employers and hospitals together in face-to-face conversations to drive improvements in healthcare outcomes. The goal is to improve quality by eliminating misuse and overuse of care, and through these efforts, lower cost and enhance the individual’s experience with the health care system.
QIC chapters are up and running in New York, Seattle and Charlotte, with new chapters soon to launch in Dallas, Atlanta and the mid-West. This effort examines a number of areas, including C-sections, spine surgery, cardiac care, emergency room usage, readmissions, radiology and serious but wholly preventable incidents called “never events.” These are all focus areas for employers looking to leverage best practices, close provider-level quality and outcome gaps, and improve the overall patient experience.
Feedback from participating employers and healthcare providers has been very positive and the results are good. In New York, several large participating health systems have confirmed they are undertaking initiatives to improve their C-section rates. In Seattle, among health systems that participated in QIC and other quality initiatives we have seen a reduction in C-section rates of up to 10%. Overall, in the US, unnecessary C-sections drive more than $4 billion of spend. (Spend related to unnecessary C-sections estimated based on cost of C-sections versus vaginal births from “Cost of Having a Baby in the US”, Truven, January 2013 trended forward to 2018; birth data from CDC births in the US, 2015; ideal C section rates from WHO Statement on C Section rates.)
At Mercer, we recognize healthcare is local. We’re excited to act nationally to improve quality locally and we encourage other employers to get involved.
You can join a QIC chapter to engage directly in conversations with health systems. Contact Sharmila Shankarkumar.