Driving Health Plan Quality: A Call to Action for Employers

It’s a well-known fact that health quality varies greatly across the country. It varies across physicians, hospitals, and – as we know from our own data — health plans. For example, in high-performing health plans,66% of adults with diabetes demonstrate HbA1C control. In the lowest-performing plans, only 37% do.

Employers can be a key driver of plan performance. Yet in a series of interviews with large employers conducted earlier this year, we learned that employers’ focus is not on quality when choosing a health plan. Instead, they look outside the plan and implement ancillary programs, such as those to identify high quality physicians or offer second opinions when needed.

These programs have noble intentions and have undoubtedly improved care for employees. However, we worry that this approach may unintentionally disincentivize the health plan from improving their networks’ performance. It is also putting the onus on employers to engage multiple vendors to manage their employees’ care — care that at one time was the responsibility of the health plan.

As employers embark on a new season of health plan RFPs, they have the opportunity to reexamine their relationship with their health plan and take a more progressive approach to quality. To help employers on this path, we are happy to share our new toolkit: Driving Health Plan Quality: A Call to Action for Employers. This toolkit assembles the quick, easy and necessary tactics and tools employers can use to drive health plan quality.

  • Need a standardized way to assess the quality of your current or prospective health plans? The toolkit tells you how.
  • Want to specify your expectations for quality during the RFP and contracting process? We give you language to use.
  • Ready to move to a more progressive strategy? We highlight data you can use for performance-based incentives.

The toolkit contains new and easy ways to drive plan performance, and we’re excited to help employers move in this direction. If you need data or benchmarks, or if you want more details, we’re here to help.

Contact us at employerrelations@ncqa.org.