Driving Health Plan Quality
A Call to Action for Employers
Driving Health Care Quality: A Call to Action
Since the 1990s, NCQA’s Health Plan Accreditation, HEDIS®1 (Healthcare Effectiveness Data and Information Set) and CAHPS®2 (Consumer Assessment of Healthcare Providers and Systems) have provided a way for employers to understand the quality of care offered by health plans. Combined, these three programs help employers understand a plan’s performance and its ability to positively affect employee health.
Employers have long struggled to keep up with the ever-increasing costs of providing health care to their employees, yet the underlying issue driving much of these costs, poor quality care, remains. In recent years, employers have implemented programs to improve health care quality by addressing gaps in care and directing employees to high-quality providers. These programs have undoubtedly improved care for employees. However, they may unintentionally disincentivize the health plan from improving their networks’ performance.
Learn more about how employers can assess, mandate and incentivize health plan quality.
Assessing Health Plan Quality
Leveraging NCQA Data to Choose a Quality Partner
The Accreditation process provides employers with data and information they can use to ensure that they select a health plan partner that emphasizes quality processes and outcomes. As employers begin the selection process, they should ask current and prospective plans specific questions.
Learn more about how you can leverage NCQA data to assess your health plan quality, and questions you should ask during the RFP process.
Mandating Health Plan Quality
Contract Language Demonstrating the Employer’s Expectations of Quality
Employers can take a more assertive approach to health care quality by requiring health plan partners to achieve minimum thresholds of acceptable performance.
Learn more about the contract language top employers are using to ensure plans are committed to quality
Incentivizing Quality Improvements
Using HEDIS to Align and Improve Health Care Quality
Even though data shows that health plan performance varies significantly, there is little incentive for plans to improve the care they offer. Employers—and self-insured employers, specifically—can change this paradigm by aligning incentives to health care quality. This sends the message that quality is important and holds plans accountable for their performance. It also drives year-over-year improvements in health care quality at the population level.
Learn more about using HEDIS to align and improve health care quality.