Let’s face it: Health care quality is tricky. It can vary by region, by provider practice and even by provider. And unless you are well acquainted with the health care system or practice medicine, you probably don’t have access to data that could help you identify a high-quality provider when you need one.
Retail Reform: Walmart
That’s why the news about Walmart’s efforts to help their employees identify high quality providers caught our attention. Beginning in January, Walmart will introduce a new pilot program. Employees in central Florida, the Dallas-Fort Worth area and northwest Arkansas will have access to Featured Providers, a program that helps connects employees and their dependents with doctors who have demonstrated they provide high-quality, appropriate care. Employees who choose a highly rated provider will pay less for higher-quality care—a potential win/win for employee and for employer.
Employers Influence Quality
Although Walmart’s approach breaks new ground, all employers—large and small—have access to data they can leverage to drive health care quality for their employees. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS® ) was created to bring transparency to how health care is provided. We collect and analyze nearly 100 measures documenting the clinical care received by more than 190 million Americans. These measures represent evidence-based actions shown to impact health outcomes.
Employers can access HEDIS in two ways:
• NCQA’s State of Healthcare Quality Report contains national benchmarks for each measure and compares the performance of different payers (commercial/Medicaid/Medicare).
• Quality Compass®1 provides in-depth analysis. Users can examine quality improvement and benchmark plan performance across years, regions and health plans.
Employers should assess which measures are most important—preventive services, chronic condition management, overuse/appropriateness… or something else—and ask how their health plan’s performance compares. Then ask them to create an action plan to improve.
Matt Brock is the Director of Communications at NCQA. After more than two decades working in broadcast journalism, Matt now leads NCQA’s efforts to develop unique content that engages and informs consumers as well as providers, plans and policymakers via this blog, our website, NCQA.org and numerous social media platforms. Matt’s goal is to educate consumers and to direct them to the best resources when considering quality in their health care decisions.