Employers, who help provide insurance to nearly half of all Americans, are key gatekeepers in the health care system. They now have access to easily understood data to empower them to promote improvements in the quality of care.
"These data allow people to identify high-quality providers, clinicians to receive meaningful and actionable feedback, and employers and health plans to curate higher-quality networks and referrals," according to a report in NEJM Catalyst. "Employer-sponsored health care should be an investment into the overall well-being of employees and their families; as purchasers, employers are in a unique position to set a new quality standard for the U.S. health care system."
Employer-sponsored insurance is the most common source of coverage for Americans, insuring approximately 180 million people and accounting for more than $1 trillion in health care spending annually. Given their substantial investments in health coverage, it is reasonable for employers to assume that individuals covered through sponsored health plans are receiving consistent, high-quality care
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Variation in provider quality is an important cause of poor health outcomes, missed opportunities for lifesaving treatment and unnecessary utilization. Historically, physician-level variation — which manifests across the spectrum of clinical practice including diagnoses, clinical processes and treatment plans — has been difficult to measure, in part because data to measure quality have been siloed by payer. However, new data assets and approaches are increasingly available to evaluate provider quality in robust, clinically relevant ways.
Related: More than half of health plan members less than happy with coverage, survey finds
One way in which employers can foster broader quality improvement is to create an information ecosystem that allows members and providers to access and act on provider quality information. This serves three purposes:
- First, it helps better inform employees' choices about the physicians they might choose for specific needs.
- Second, it creates an environment where physicians receive feedback regarding where they are performing well and how they can improve.
- Third, it gives employers the basis to curate higher-quality networks and steer their employees to high-quality clinicians.
When employers provide their members with transparent quality data on provider performance, they simplify the patient process of identifying and choosing high-quality doctors.
"Employers are currently in a unique position to improve the quality of care for the millions of Americans with employer-sponsored insurance and to set a new standard for the U.S. health care system," the report concluded. "Despite the high cost of employer-sponsored insurance, covered members continue to receive variable care that may fail to meet quality standards. By leveraging provider-level quality data in their operations and making these data accessible to their members, employers have a timely opportunity to take a leading role in creating a health system that consistently delivers high-quality care for employees and their families."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
