NCQA Talks with Employers About the Health Plan Selection Process

Over the last year, we learned several ways that employers are addressing health care quality. From implementing new programs to help identify and steer employees to quality doctors, to expanding Centers of Excellence programs to address more complicated health issues, employers are driving quality in a multitude of ways. But these efforts often entail additional vendors and programs to augment care that the health plan is supposed to manage. It made us wonder if any efforts were underway to ensure that health plans themselves are high quality.

To find out, we asked 25 employers and 4 consulting firms how often employers select a health plan, what criteria they use to select a plan and how they approach the issue of quality with plans. Here’s what we learned:

  • Employers find the traditional RFP process to be onerous and costly, and it rarely results in a vendor change.
  • Employers largely select plans based on 5 things: Networks, member experience​, provider discounts, claims processing and willingness to innovate.
  • 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.
  • A small group of employers want to uncouple the claims process from the network they use. An independent third-party administrator would adjudicate claims and make benefits decisions; the health plan would be used only for its network and, potentially, some ancillary programs.

Although employers are interested in health care quality, they aren’t leveraging existing tools to identify high quality plans, such as NCQA’s Health Plan Accreditation program, yet we know that Health Plan Ratings and HEDIS®[1] measure results show wide variety, indicating that plans can influence quality. We’ve taken this intelligence to heart and realize that we have some work to do in educating employers on the data available to them.

What have we been up to? Stay tuned for our next update or reach out to us at employerrelations@ncqa.org to learn more.

[1]HEDIS® (Healthcare Effectiveness Data Information Set) is a registered trademark of the National Committee for Quality Assurance (NCQA).