Americans rely significantly on health care coverage from their workplaces. Employers play a crucial role in offering such benefits but face limitations in driving widespread innovation. The health care system's financial incentives often prioritize service volume over quality, leading to cost growth. Employers direct a substantial amount of funds to health care each year, and it's time to leverage this purchasing power. Insights from interviews with employers highlight the need for peer learning. Morgan Health, in collaboration with JPMorganChase benefits, developed a roadmap for employers to measure health care quality.

Key Steps for Measuring Health Care Quality

Identify Improvement Opportunities

Understanding the current health status of the member population is essential. For instance, high levels of A1c among a member population or sub-populations can lead to setting a goal of reducing diabetes prevalence. This helps employers identify gaps in health care quality and needed interventions.

Select Quality Measures

Improving care quality can take various forms depending on an employer's population health needs. Measures such as reduced hospitalizations, enhanced access to screenings and preventive care, or improved provider scores provide deeper visibility into patient engagement and potential cost savings.

Determine Baselines and Set Targets

Accessing a patient's longitudinal data can be challenging due to factors like turnover or changes in benefits. However, national benchmarks like those in NCQA Quality Compass can assist employers in establishing measure baselines. By examining HEDIS benchmarks or evidence-based research studies, employers can set targets.

Establish Performance Payments

Setting payment incentives and agreeing on fees-at-risk for performance is crucial for establishing accountability. Employers and vendors should discuss the best approach for the first year and align around long-term goals to drive continuous improvement and trust.

Establish a Timeline and Process

Documenting how baselines are set and results are calculated is important. This ensures all parties in the contract are aligned on measure methodologies and is particularly useful during audits when quality measures are tied to financial incentives and accountability.Innovations in care delivery are advancing rapidly, and payment models need to keep up. As large purchasers of health care, employers can collaborate to support the shift from volume to value across the system.