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Iowa Employers to Rate Health Care Providers

Rating Iowa Health Care ProvidersIn our 2013 survey, we are asking Iowa employers to rate hospitals and physicians within their communities on 11 important performance measurements. Without a doubt, this particular module of our 2013 Iowa Employer Benefits Study© will be quite fascinating. To the best of my knowledge, Iowa employers have never been asked to rate health care providers in their communities – until now.

It’s about time.

Asking Iowa employers to rate health care providers will be important for a number of reasons. Two key reasons are:

  1. Employers contribute a considerable portion of the medical insurance premium for employees and their families. From our 2012 Iowa Employer Benefits Study©, the average employer contributes about 80 percent of the employee-only premium, or about $4,400 annually. The employee contributes the other 20 percent, or $1,065 annually. For employees with family health insurance coverage, the employer pays about two-thirds of the annual family premium ($8,900), while the employee pays the other one-third ($4,657). Needless to say, the average Iowa employer is very generous when picking up the health care tab for their employees.
  2. Despite annual premium increases, Iowa employers have CONSISTENTLY absorbed escalating costs since 1999 (the first year our Study began).  Employers make this ‘investment’ to maintain and improve the health and well-being of their workforce. The illustration below compares Iowa to the national average on employee contributions for health coverage since 1999. The national numbers come from Kaiser/HRET.

Average Percentage of Premium Paid by Covered WorkersThe two reasons above help illustrate the necessity of having Iowa employers provide input on the “value” they receive from this considerable outlay of money to our health care provider community. How Iowa employers perceive the performance of health care providers will cast an important light on measurement area(s) that may need improvement. Our new module of questions will help us understand just how satisfied employers are with this perennial investment. We do realize, however, that there are other external influences that must be accounted for when assessing the provider communities – such as public policy issues, insurance vendor arrangements, patient engagement, etc. 

The 11 performance measures will be based on a 1 to 10 scale, where 1 means “failing” and 10 means “excellent.” The performance measures for both hospitals and physicians include:

  • The transparency of costs
  • The transparency in medical outcomes
  • The coordination of care among providers
  • Keeping costs reasonable
  • Consistent quality of care
  • Focus on wellness and health promotion
  • Access to services
  • Electronic health records
  • Efficiency
  • Concern for patient satisfaction
  • The ability to engage patients

Finally, employers will also be asked to provide feedback on how much they trust (or don’t trust) the medical provider community in which they operate. As mentioned in previous blogs, TRUST is an extremely important measurement to any industry, but absolutely critical in the health care world.

The results of this important survey will be published early this Fall by our new, sister organization, Heartland Health Research Institute and will be shared with the public.

To learn more, we invite you to subscribe to our blog.


Expansion of Medicaid – What REALLY Matters?

Quality care diceA new randomized and controlled clinical trial provides fascinating information for Iowa (and other states) to review while policymakers consider whether or not to expand Medicaid. I highly encourage you to read this study, as it helps frame the real issues we must focus on as a state and country.

Published in The New England Journal of Medicine, ‘The Oregon Experiment – Effects of Medicaid on Clinical Outcomes,’ study reviews the potential effects of expanding Medicaid to impact healthy outcomes when health coverage becomes available to low-income adults. As you have correctly guessed, the petri dish for this experiment was the state of Oregon.

When expanding Medicaid for the poor, the primary benefits can be lower depression rates, greater health-care utilization and the elimination of catastrophic medical expenses for those who acquire the insurance. According to the study’s primary author, Katherine Baicker, a Harvard health economics professor, “The purpose of insurance is not to just get you access to healthcare, it’s to protect you from financial ruin if you have an expensive condition.” Dr. Baicker was one of many speakers at Harvard’s “Forces of Change” series on healthcare that I attended in Boston a few years back…she is a wickedly smart and a concise researcher.

In Iowa, a great debate has erupted (mostly along partisan lines) about whether to expand Medicaid or pursue a new but untested plan offered by Governor Branstad. Both approaches have supporters and critics for a number of reasons – arguments founded on facts, emotion and, you guessed it, politics.

So what is the truth?

I don’t pretend to have the answer. However, the Oregon Experiment does give additional insight on the implications for any legislative activity enacted in this state. It is common knowledge that having insurance coverage allows us to seek medical care that will make us healthier and more productive…and we won’t go bankrupt. We also know that having insurance provides each of us a peace of mind, it certainly does for me. Finally, having insurance improves access to healthcare providers and services. Enough said, right?

Not so fast – after learning of this new study, we may need to reassess this logic and maybe qualify it a bit more. The study findings consistently support the importance of delivering QUALITY health care to our population. To borrow a quote from Dr. Ashish Jha, another wickedly smart physician and researcher at Harvard, “The explanation is simple. It’s not about access to healthcare; it’s about access to high quality healthcare.” Baicker’s recent study certainly supports Dr. Jha’s conclusions.

We cannot expect to have a healthier population by merely providing insurance to gain access to necessary care. In fact, there is evidence that shows doctors who spend a great deal of their time serving Medicaid recipients deliver lower-quality care. Insurance will unlock the door to gaining access to care, but having this access does not ensure we receive quality care that will improve our health.

The Affordable Care Act (ACA) attempts to improve access to care for those least fortunate in our society – and most everyone agrees that this is important. However, the ACA does little to control spiraling costs and improve the quality of care being delivered. By adding more insureds into an already dysfunctional, high-cost ‘system,’ will only make our health costs considerably greater and even more uncontrollable over time.

It’s like rearranging the chairs on the Titanic.

Improving the health of our population means that we must pursue logical steps to ensure that high-quality care is being delivered at a reasonable cost. Gaining access to care is not enough…we must commit to having high-quality care accompany this access. Dr. Jha articulated this point very well: “Quality is the link between healthcare services and better health outcomes.”

It is time to make sure this healthcare ship is traveling in the right direction. It’s what we all should demand…it’s what we all deserve!

To learn more, we invite you to subscribe to our blog.

Happy 15th Birthday!

Birthday Cake for 2013 Iowa Employer Benefits Study

Our annual Iowa Employer Benefits Study© is about to take place. I’m really looking forward to this year’s survey for these important reasons:

  • This will be the 15th Study conducted since we started this particular survey in 1999. Some ‘birthdates’ are celebrated with more meaning than others…and 15 is a significant amount of time to show trending patterns and establish a credible track record!
  • Three new modules of questions will be added in this year’s Study.

1. The first module will gauge whether employers will keep their health plans (this would apply to those employers with 50+ employees). In addition, we will determine how prepared employers are regarding health reform requirements. This module is extremely relevant because employers will be making decisions for 2014, the first year most health reform provisions will take effect.

2.  The second new module will be added that will determine how Iowa employers view their local community health care providers – specifically hospitals and physicians. Modules two and three will begin to address the upstream portion of ‘Our Health Care River.’ Our newly established company, Heartland Health Research Institute, will then begin to tackle the implications of the results from these two modules.

In this module, employers will grade hospitals and physicians on 11 key issues, including: transparency of costs, outcomes, coordination of care, concern for patient satisfaction, ability to engage patients, and so on. In addition, employers will be asked to measure their TRUST of these providers. Measuring trust is extremely important for a number of reasons. David Shore, Founding Director of the Trust Initiative at Harvard School of Public Health, once said that ‘trust is the currency of commerce.’

To learn more about the trust issue in health care, please see my earlier blogs:

The Currency of Commerce (Part 1)
Trust – A Distinguished Healthcare Trait (Part 2)
Trust – Now is a Good Time (Part 3)

3.  The third module will address the type of data needed by employers to manage employee health costs. It will help identify who should have the responsibility to supply the primary source of this data to employers and their employees (i.e. health insurers, government or health providers – such as hospitals or physicians.) In addition, we will learn how knowledgeable employers are regarding the Iowa-based web resources currently available on our Iowa hospitals.

Rest assured, we will continue to ask our core questions about the benefit components being offered by Iowa employers. After all, this is the initial reason we began this groundbreaking Study 15 years ago. One thing I have learned over the years of conducting this Study is the importance of constantly monitoring the marketplace — asking fresh questions and addressing new and potential trends.

If your organization is randomly selected to participate in this year’s Study, we highly encourage you to share in our celebration by participating in the survey. Here’s to adding the 15th candle to our cake!

To learn more, we invite you to subscribe to our blog.