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Employers and Health Data – Who is the Trusted Resource?

Health care data Resources in IowaLast week’s blog discussed a new module of questions we have included within our 2013 Iowa Employer Benefits Study©. Within this new module, employers are being asked to rate hospitals and physicians within their communities. Probing further, we included another battery of questions to gauge how employers feel about another health-related issue – identifying a reliable source to supply specific health care information to employers (and to their employees).

Frankly, these questions boil down to just one word – Trust.

Which resource does the Iowa employer trust when accessing and evaluating health care information for their employees? Would it be insurance companies? Maybe the medical provider community is most trusted, such as hospitals and/or physicians. The federal government is yet another possibility (I’m a bit suspicious, however). Perhaps, none of the above mentioned stakeholders, but instead, a trusted third party that has yet to emerge in this new evolving marketplace. Logic tells me that employers would like to use a combination of the above resources – not just one source. Much of this, I suspect, will also depend on the type of medical data that is desired by employers.

A large portion of the questions found in this particular module come from the Iowa Hospital Association (IHA). Transparency of health costs and effective health outcomes information is becoming a trendy discussion these days, with special thanks to the Affordable Care Act (ACA). The IHA has a great deal of interest in understanding how Iowa employers perceive these critical issues, and in learning more on how such information can be conveyed in a meaningful conduit of media (electronic format being the most likely culprit).

I applaud the IHA for their desire to find new ways to communicate and educate a major stakeholder (the employer) regarding local health care information. The healthcare snow globe in which we live continues to provide new opportunities for those willing to take the plunge to make our current health care ‘system’ a better place for all of us.

This particular survey module will provide us with additional insight on who should be providing this important information to Iowa employers, and what this critical information should convey.

The results of this survey will be published early this Fall by our new, sister organization, Heartland Health Research Institute.

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

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.