Employers Unaware of How to Compare Health Plan Quality Measures

Employers find the health plan selection process cumbersome and are not aware of how to compare health plan quality measures using the National Committee for Quality Assurance (NCQA) tools, two NCQA surveys recently revealed.

The organization connected with over two dozen employers and four consulting firms to explore the health plan selection process from an employer’s point of view.

The NCQA is especially invested in the answer to this question because its different quality measures, including the Healthcare Effectiveness Data and Information Set (HEDIS), are designed in part to help employers assess plan quality as part of this process and compare plans.

In order to select a health plan, employers will engage issue a “request for proposal.” The request for proposal may go through more than one iteration but, ultimately, it will detail what an employer is looking for in a health plan and healthcare benefits for its employees.

Employers stated that the process is “onerous and costly.” It also does not appear to be extremely effective, since many reported that their requests for proposals left them with the same health plan that they had originally.

“In general, employers don’t feel that the RFP process leads to selecting a high-quality health plan. Nor do they feel health plans do a good job ensuring that employees get access to high-quality care,” NCQA explained.

The employers who participated in this survey noted five major priorities in their health plan selection process.

First, they looked at the provider networks. Employers are looking for broad networks that can service a wide variety of needs.

Second, they looked at member experience. With this as one of their five major priorities, it is no wonder that employers have been disenchanted with their health plans.

A recent JD Power survey revealed that health plans continued to receive low consumer satisfaction with their member engagement. While payers touted their outreach programs and member engagement efforts during the coronavirus pandemic, consumers were not impressed.

Six in ten members in a private health plan said that they were not contacted by their health plan with coronavirus-related information, JD Power reported. Meanwhile, nearly half of the respondents (48 percent) said that, during the height of the pandemic, their health plan did not show concern for them.

The last three factors that the employers looked at were provider discounts, claims processing, and health plans’ innovativeness, NCQA continued.

Separate from the survey, NCQA shared certain data points with employers to help them through this process of comparing and selecting plans.

“Employers will learn a great deal about the health of their populations by asking how their plan compares to state and national benchmarks,” the

NCQA assessed the key performance measures that employers were looking for and showed how the employers’ current health plan performed alongside state and national benchmarks. The results were surprising to employers, NCQA said.

The organization zeroed in on the quality metric of HbA1c management for diabetes, a common quality measure since diabetes is so prevalent and mismanaged diabetes can to lead to poor member outcomes and high healthcare spending.

Two-thirds of individuals with diabetes in the top ten percent of health plans were able to manage their chronic disease. For lower quality plans, this fell to less than four in ten (37 percent).

Sometimes employers are completely unaware of their health plan’s nationwide ranking. NCQA recognized that employers were unaware of the tools that NCQA provides to compare health plans.

“There is a great opportunity for employers to leverage plan and population data to drive quality improvement at the plan level,” NCQA found. “A few innovative employers are putting performance guarantees around care quality and holding health plans accountable, but most are not.”

If employers do achieve greater awareness about the health plan rankings, it could change the plan selection process. As it is, for the past several years in particular, employers have started exercising greater control over their healthcare spending as employer activists.

“Very frequently payers are partners with employers in this. Both have an interest in rewarding providers who are performing at a higher level on quality, cost, and patient experience,” Steve Wojcik, vice president of public policy at the National Business Group on Health, told HealthPayerIntelligence in an email interview.

“Health plans work with and welcome employer support for engagement with providers. A united front and working together makes a more compelling case to the need for delivery transformation.”