Everyone is for quality – there is no debate. Employers are directly affected by poor quality healthcare, which not only drives up medical spending but also, according to this NCQA report, leads to as many as 45 million avoidable sick days every year, which is the equivalent of 180,000 full-time employees calling in sick every day for a full year. Just one example of a systemic problem with healthcare quality is seen in data showing that Americans get only half of the recommended care for their chronic conditions.
To combat these quality gaps, employers have deployed wellness programs, employee assistance programs (EAPs), and other health management strategies that promote healthy behaviors, help employees get better care, and support management of chronic conditions. Some organizations have joined collaboratives with healthcare providers and other stakeholders to develop and implement business models to achieve better outcomes and lower costs by leveraging purchasing power.
But despite all of this, employers typically have limited insights into the quality of healthcare services that they routinely are purchasing. When they are able to receive healthcare quality information, it is usually limited to administrative information from claims data. Although claims data provide some indications directionally on quality, it is not adequate, since these databases were created for payment and not for quality measurement.
But times are changing as health technology solutions are emerging. With the increasing use of electronic health records (EHRs), more meaningful quality data can be obtained and analyzed. Public and private sector value-based care programs, such as accountable care organizations (ACOs), routinely require quality reporting from provider organizations in order to demonstrate quality of care for a designated population. Indeed, quality reporting is a requirement to receive bonus payments for some ACO arrangements.
Here are some healthcare quality strategies that employers can use with carriers and provider organizations:
- Work with your health plan and other partners (consultant, carrier, carve out vendors) to select meaningful and nationally validated quality metrics for the population
- Request periodic reporting on healthcare quality metrics with national benchmarks to see how well the provider network is performing
- Implement health plan and vendor contracts that put fees at risk based on the performance of the selected quality metrics
- Consider ACO or other value-based care arrangements that incorporate meaningful and nationally validated quality metrics that demonstrate improvements in quality as part of the formula for provider reimbursement
- Ask for improvement plans from the provider organization and carrier/administrator when quality metrics are not meeting goals and national benchmarks
Employers have the potential to accelerate real and lasting improvements in the quality of healthcare services. As the provider of health benefits for the majority of Americans, employers can guide the way their employees select providers and manage their health. Employers can require both quality and cost information when making their benefit decisions. Using quality information in health benefits, just like any other goods and services that employers purchase, will drive the kinds of improvements in healthcare that are clearly needed.
To help employers leverage their purchasing power to effect meaningful change, Mercer launched the Quality Improvement Collaborative (QIC), which brings together multiple plan sponsors in a given market to dialogue with provider organizations regarding healthcare quality initiatives, improvement projects, and achievements. For more information, please contact Sharmila Shankarkumar, Mercer’s National QIC Leader, by telephone at 212-345-2746 or by email at firstname.lastname@example.org