Blog Post: The time is right for employers to create a path to better value in health care by Cheryl DeMars, President and CEO of The Alliance

Blog Post: The time is right for employers to create a path to better value in health care by Cheryl DeMars, President and CEO of The Alliance

It was an honor to present at The Action Group’s Community Dialogue on Joint Replacements for Hips and Knees on March 28, 2014, and to share and compare best practices in this area where the number of procedures performed is rapidly accelerating. As the keynote speaker, my role was to discuss the importance of improving orthopedic value from the buy side, and to share how The Alliance is working with its members to drive toward greater transparency.

The Alliance believes that employers, as purchasers of health care, are key to accelerating the sometimes agonizingly slow progress toward better value health care. We have launched an initiative called QualityPath to help advance this effort.

QualityPath to accelerate progress

QualityPath_logo_web QualityPath intensifies the role of employers to drive quality improvement and cost control at a faster rate. Employers are at the center of this effort for multiple reasons:

  • Employers who self-fund their health benefits have the data to understand the impact of cost and quality differences on both their bottom lines and their employees’ health and wellbeing.
  • Employers, as the purchasers of health care services, will have a greater impact on the market when they come together to buy based on value. This is the essence of The Alliance.
  • Employers have the opportunity to send clear signals to employees and family members about the benefits of choosing doctors and hospitals that meet proven quality standards at a fair price.

Getting feedback from stakeholders

The Alliance chose to publicly announce the QualityPath program at the start of the development curve — rather than waiting until it was ready to launch — to gather input from everyone with a major stake.

  • Employers have been asked to commit to exploring value-based benefits to create clear incentives for employees to use high-quality, fairly priced providers.
  • Agents and TPAs have been asked to share insights on which benefit plan designs are effective in steering employees to better care and to help operationalize this program.
  • Physicians and hospitals have been asked to share information about quality for selected procedures, starting with cardiology and orthopedics. Physicians and hospitals receive a QualityPath designation if they meet or exceed thresholds for quality and agree to provide these services at a lower cost. In exchange for doing so, they can expect to see greater market share because of the steps employers take to direct employees through benefit plan design.

Physicians and health care organizations have offered valuable insights and urged us to move forward. One physician CEO noted that he does not yet know how his organization will fare on the QualityPath assessment of cost and quality but sees this as “exactly the right thing for employers to do.”

Support needed

Employer participation is key. And support from Alliance members has been encouraging. Employers representing significant numbers of employees and family members have added their names to the list of organizations that have agreed to explore QualityPath. We’re off to a great start, and our members have been formally pledging their support.

I understand that a number of Action Group members have pledged their support for change by organizing around Learning Networks for back pain, maternity and infertility, and now total joint replacement. Designed to provide facilitated learning to help purchasers increase the value of care that is often subject to overuse or inappropriate use, these Learning Networks present an ideal opportunity for employers to band together and use their collective strength to assure that their employees are receiving the best possible care at the best possible value, resulting in satisfaction for all.

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