Since 1988, average employee premium contributions for medical insurance have more than doubled, while deductibles have increased by more than 100 percent. Although large employers want employees to choose providers based on quality because of the cost savings associated with better healthcare, the health plans they offer deliver inadequate decision support. According to a new report from Forrester Research, Inc. (Nasdaq: FORR), health plans should align members’ and providers’ motives on quality, which will drive market share to better hospitals and doctors.
“The marketplace for quality healthcare is immature,” said Bradford J. Holmes, senior analyst at Forrester. “If employees are expected to make better healthcare decisions with and about their providers, employers will need to demand higher proof of performance from caregivers. The key is to make sure that plans align members’ and providers’ incentives with quality care and — where measurable — better results.”
To make both employees and providers accountable for better health outcomes, plans should first start tracking processes and evaluating outcomes. Several vendors already measure quality, but the depth and breadth of their capabilities varies greatly. Plans should work to reach consensus about quality metrics to boost comparability between hospitals. They should also partner with a reputed quality assessment vendor that evaluates hospital and doctor performance and considers consumer preferences.
Next, plans should motivate consumers to favor hospitals or doctors with documented best practices and better outcomes. A way to change members’ behavior is to communicate the health consequences of misuse of care. Highlighting the negative health consequences of currently flawed practices to raise awareness, as well as offering positive solutions, also promote quality.
Last, investing in technology is another way plans can repair broken decision support to improve overall relationships with consumers and clearly articulate treatment choices. A successful Web site is one in which the financial implications of consumers’ choices, as well as best practices for quality healthcare, are evident. Companies that create support content at each step of the decision process can better promote quality.
By 2003, employers and their consultants will start measuring plans based on their ability to move consumers to better hospitals and doctors. To gain credibility with primary care providers, plans should tout their use of preventive services and teaching self-care. Plans must also highlight over-prescribed medications and procedures, and target misuse and errors in competitive services like heart surgery.