The Value of Quality

Quality in health care has been hailed as one of the goals of health care reform ever since “Crossing the Quality Chasm” brought the issue into public focus. Groups of large employers, such as the Leapfrog Group, have utilized hospital safety measures to monitor and encourage use of high quality health care providers. However, the authors of this study demonstrate poor use by American employers of value based purchasing strategies that have the potential to incentivize “quality.”

Employers (n=609, response rate 64%) representing 41 major U.S. markets, each having greater than 50 employees and situated in areas with a minimal level of HMO market penetration, were randomly selected for interviews to determine the proportion of employers influenced by health quality data when selecting health plans.

When choosing health care plans, employers tend to regard geographic distribution of providers (80%), customer service (83%), and premium rates (88%) as the most important characteristics. Although 65% of employers examine health care plan quality data, only a small minority disseminate this information to employees when selecting a plan. Twenty-three percent provide quality report cards and only 9% differentiate employee contributions to plans based on quality data. Utilization of information about the quality of physicians and medical groups occurs even less frequently. Few employers provide quality report cards (8%) to employees and a minuscule amount use tiered co-payments (1%) to encourage the purchase of quality health care. Employers tend to focus their energy on chronic disease management, health education, and health promotion strategies to encourage their employees to remain healthy.

A minority of employers view value based purchasing tactics – such as sharing quality data for hospitals/physicians (42%), health plans (36%), or using financial incentives for employees to choose high quality health care services (35%) – as “very useful.”

Commentary:

Improving quality in the health care system may prove difficult using the tools of the current health care market place. Very few employers think it worthwhile to provide quality data to employees and hence, only a small minority actually uses value-based purchasing tactics when selecting health care plans. Perhaps the private market is not the best place to leverage quality care from health care providers.

JAMA. 2007. 298 (19): 2281-8.