Dive Brief:
- Ensuring workers can find and access high quality providers is key to tamping down healthcare costs and improving outcomes in the employer-sponsored insurer market, according to a study by Morgan Health and Embold Health published in NEJM Catalyst.
- Employers can now access more data on the quality of care provided by clinicians, so they should take a larger role in health plan network design and steer workers toward higher performing providers, according to the report.
- Clinician quality can drive poor outcomes, missed treatments and unnecessary care, the report said. For example, among the top 10% of about 800 cardiologists in Ohio by quality rank, an average of 73% of patients with coronary artery disease were taking cholesterol-lowering statins regularly, compared with only 39% for the bottom 10% of clinicians.
Dive Insight:
Employer-sponsored insurance is the most common way for Americans to receive health coverage, but cost has increased significantly for both workers and their employers over the past decade.
In 2022, average annual premiums for family coverage reached $22,463, with employees footing the bill for $6,106 of that cost, according to health policy research firm KFF. In comparison, average premiums were $15,745 for family coverage in 2012.
Healthcare costs may increase by 6% in 2023 and 2024, according to a recent survey conducted by the Business Group on Health, with large employers particularly concerned about the rising cost of medications.
The report by Morgan Health, a business unit at J.P. Morgan Chase, and data analytics firm Embold Health notes employers have a “critical” role when it comes to bettering quality and outcomes.
Though businesses have traditionally left network design to insurers, the report argues employers should take a larger role to increase the likelihood that workers can see high-quality clinicians, incentivizing their members to go to better providers in exchange for lower out-of-pocket costs.
“By shifting member volume to high-quality providers, employers instill greater motivation for providers to shift toward evidence-based clinical decisions and improve their own quality,” the report’s authors wrote.
Employers should build provider search guides that incorporate quality metrics, so their employees can choose clinicians that perform well based on their specific healthcare needs. They should also focus on entering accountable care contracts so providers are financially incentivized to improve quality for members.
