How to Be a Better Benefits Buyer

Employers spend thousands per employee on health insurance plans. Yet few check the quality of their plan before buying.

When you want to buy a car or appliance or hire a contractor, you can check Consumer Reports and Angie’s List for quality ratings. Few would argue that using rating services such as these can save consumers money and aggravation. Yet many employers don’t take advantage of rating services available when they buy their employee group health plan.

A recently released survey of employers that offer employee health insurance found that most don’t use any objective quality information or ratings in their decision-making process. That’s like buying a car because it’s cute or you like its color, and hoping for the best.

Anne Weiss, who leads efforts to increase health care value at the Robert Wood Johnson Foundation, said the poll “highlights the fact that there is still a lot of work to be done to educate employers on how to get the most bang for their buck.” The survey, conducted by the Associated Press NORC Center for Public Affairs Research, was funded by the Robert Wood Johnson Foundation.

Sixty percent of employers offering health insurance said quality ratings were an important factor when choosing a plan. Despite this, most employers (89 percent) did not use or know about objective health insurance quality information and ratings available. Only 7 percent used objective quality information when buying employee health coverage.

That’s not to say that most employers are making blind decisions — many rely on other sources. Health plans provide quality information; 36 percent of employers offering health insurance use this. Another 15 percent of employers use brokers or consultants to evaluate health insurance plan quality. These sources might provide useful information, but are they as unbiased as other sources? To get a true picture of a health plan’s quality, you might want to consult unbiased sources.

Where Can You Find Plan Rating Information?

The Associated Press-NORC survey gauged familiarity with four different sources of quality information: HEDIS scores, NCQA, eValue8™, and CAHPS data. An overview of each follows.

HEDIS Scores: Healthcare Effectiveness Data and Information Set scores. The National Committee for Quality Assurance (NCQA) collects these health insurance plan quality ratings. NCQA looks at three measures to develop its ratings: clinical quality, consumer satisfaction and NCQA’s review of a health plan’s health quality processes. If your plan isn’t listed, that might not necessarily reflect on its quality or lack thereof. NCQA only ranks health plans that publicly report their quality information.

The NCQA also issues a State of Health Care Quality Report every year. Instead of focusing on individual plans, the report takes a look at the key quality issues the U.S. health system faces and progress toward providing evidence-based medicine. You can obtain a copy at no charge at http://store.ncqa.org/index.php/2014-state-of-health-care-quality-report.html.

eValue8™ Data: The National Business Coalition on Health (NBCH) represents regional coalitions of more than 4,000 mid- and large-sized employers that provide health insurance coverage to approximately 35 million employees and their dependents. This nonprofit provides research and other resources to improve the employer-sponsored health system. According to the NBCH, “eValue8™ asks health plans probing questions about how they manage critical processes that control costs, reduce and eliminate waste, ensure patient safety, close gaps in care and improve health and health care.” NBCH develops eValue8™ ratings using information on how plans handle health promotion, disease management, provider payments, and provider quality measurements.

CAHPS: The U.S. Agency for Healthcare Research and Quality (AHRQ) conducts the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. CAHPS asks consumers and patients to report on and evaluate their experiences with healthcare providers. These surveys focus on aspects of quality that consumers are best qualified to assess, such as providers’ communication skills and ease of access to health services.

All CAHPS surveys are in the public domain, which means that anyone can download and use these surveys to assess consumer experiences. Individuals and organizations use the survey results to inform their decisions and to improve the quality of healthcare services. For more information on CAHPS health plan surveys, see https://cahps.ahrq.gov/surveys-guidance/hp/index.html.

Please keep in mind that if you can’t find objective quality information on your health plan, that doesn’t mean it’s not a good plan. Rating organizations might not rate plans from smaller or regional insurers.