Employers Highlight Common Challenges and Need for Shared Learning on Quality in Employer-Sponsored Health Care

By Fatema Salam , Vice President, Health Care Innovation

Recently, Morgan Health engaged X4 Health to conduct a series of interviews with self-insured employers – mostly those covering more than 10,000 people –?to assess how they view health care quality, and identify ways in which they can place a greater emphasis on quality through their benefit plan design.

While each employer had perspectives on quality and priorities that were unique to their organization, four common themes emerged:

1. Outcomes-based performance guarantees can establish accountability for quality but are not common practice for employers today.

Tying payments to clinical quality measures can incentivize health plans, providers and point solution vendors to achieve certain quality standards but these types of performance guarantees are not common practice in employer contracts. Even fewer employers are negotiating down-side risk tied to quality performance. As a result, regardless of an employer or vendor’s passion and commitment to quality, there is often no accountability mechanism to ensure quality outcomes are incentivized or achieved. ?

2. Data barriers are a top challenge to developing an effective quality strategy.

Data on quality and outcomes enables employers to assess variation in quality outcome, identify opportunities for improvement, and evaluate the effectiveness of interventions. Yet, most employers lack an actionable, comprehensive data set and compiling medical claims across multiple data sources is challenging. This leaves many employers hamstrung in their ability take a more data-driven approach to quality improvement, making it difficult to know where to focus their efforts or to have the tools to measure improvements. ??

3. Employers want their members to see high-quality providers, but employees lack access to timely, reliable data to inform their choices.

Objective measures of quality and cost are not available to employees when they are making decisions on where to seek care. While employers can deploy strategies like narrow networks or financial incentives to help steer employees to high-quality providers, these tactics often come with tradeoffs. For example, one person may want access to a large network of providers, or prioritize a long-standing relationship with an existing provider. Employers need new tools to ensure people have the information they need to make informed choices, including arming them with transparent, timely information about the quality of their doctor. ???

4. Call for open source learning between employers.

As employers explore new approaches to care and measure their impact on quality, it’s time to work together to define what “good” looks like. Absent a standard set of quality measures, employers are experimenting with ways to improve and measure quality, but most employers only have capacity to pilot a few new concepts a year and measuring their impact takes time. Employers want to learn from others through open access to best practices and case studies that provide details around innovations in health care quality, including what worked or did not work. The more we can learn from one another, the faster we’ll improve quality in employer-sponsored insurance.

These findings underscore the critical importance of engaging employers to learn about their approaches to quality improvement and share best practices across the sector. By prioritizing quality, employers and their employees will all benefit from efforts to ensure that health care is safe, effective, patient-centered, timely, efficient and equitable.

Learn more about our work to measure and improve health care quality.