Leadership Commitments to Improve Value in Health Care Finding Common Ground: Workshop Summary (2009) / Chapter Skim
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12 Employers and Employees
12 Employers and Employees
Pages 297-308
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From page 297... ...
Over the last 10 years, employer healthcare expenditures rose 140 percent (Mercer Health & Benefits Evolution and Revolution: Benefit Trends, 2007)
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From page 298... ...
Among them is the National Business Group on Health,1 established in 1974 at the urging of the Business Roundtable.2 The National Committee on Evidence-Based Benefit Design is a recent initiative of the National Business Group on Health whose mission is to improve the quality of care and promote value by using benefit designs that encourage and reward the provision of effective care and that discourage the provision of ineffective care. Regional and community-based coalitions, led by the National Business Coalition on Health,3 took root in the early 1990s.
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From page 299... ...
Employers and employees have much to gain by encouraging evidencebased medicine: improved quality of care and improved outcomes by adherence to • clinical guidelines and through the appropriate use of services and medications; reductions in errors and adverse medical events; • potential cost savings through reductions in ineffective care, • unproven treatments, and interventions that are unnecessarily costly; and greater patient satisfaction through informed involvement in health • care decisions. ACTIVITY CATEGORIES Many employers are already active in applying medical evidence and use four levers at their disposal: Provider contracting.
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Preferential status might entail an in-network or center of excellence designation, increased reimbursement, or reduced employee cost sharing when an employee chooses a recognized provider. The Leapfrog Group, the 5 Million Lives Campaign, and the Surgical Care Improvement Project are examples of programs with standards that may be incorporated.
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Benefit Plan Design When medical evidence is available, it is incorporated into clinical practice through treatment guidelines, provider profiling, clinical decision support, and value purchasing efforts, such as centers of excellence and pay-for-performance initiatives. However, with the exception of clinical preventive services, it is still rare for sponsors to use benefit design to
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For example, a survey of nearly 3,000 employers found that 53 percent offered a health risk questionnaire in 2006, and many used incentives to encourage participation (Mercer Health & Benefits Evolution and Revolution: Benefit Trends, 2007)
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For example, one survey of large employers found that 44 percent offer employees access to health coaches, who use evidence-based guidelines when they inform patients about their care options (National Business Group on Health/Watson Wyatt, 2007)
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Expand Evidence Base with Clinical Experience and Comparative Effectiveness Research To better support decision making about the best evidence, both in patient care and in provider coverage, the evidence base needs to be expanded significantly. Information and data capture at the point of care could supplement and refine the current knowledge.
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• Use Evidence in Coverage and Payment Policies There will need to be an agreed-upon process or decision model for the translation of research into coverage and payment policy recommendations. Once recommendations are made, employers can design health benefits and write provider contracts consistent with those recommendations, reinforcing the expectation that evidence-based medicine is the standard and pricing and network steerage will be linked to the practice.
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Next steps for using evidence in coverage and payment policies are to learn from existing efforts and to develop a transparent methodology for specifying coverage criteria. Next steps for creating consumer demand include the following: Communications research is needed to understand what messages • and information resonate with consumers.
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From page 307... ...
Washington, DC: National Academy Press. The Kaiser Family Foundation and Health Research and Educational Trust.
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