How Benefits Leaders Are Measuring Provider Quality

Self-insured employers and benefits consultants are in a unique position in the healthcare industry. They’re payers, and sometimes providers, and they’re definitely influencers that determine how patients access healthcare. We’ve written about value-based care and direct hospital networking in the past. These are both tactics that benefits leaders are using to control rising costs and offer better care to members.

At last week’s Elevate client conference, we hosted a panel discussion focused on provider quality. It’s a tricky aspect of healthcare with a lot of moving parts. For one thing, there are a lot of different groups trying to measure provider quality:

1. Hospitals and health systems
2. Large employers who direct contract with them
3. Providers themselves
4. Third-party companies who solicit reviews on providers
5. Patients through online reviews
   

Our panel represented a few of these groups: Marisa Kranz, from H-E-B, a large self-insured employer in the grocery industry; Leah Binder of The Leapfrog Group, a non-profit consortium dedicated to hospital safety and quality; Shane Wolverton of Quantros, a healthcare software company that helps providers measure quality; and Reed Mollins of Doctor.com, a provider ratings and transparency website open to the public.

Each of these panelists brought a unique perspective to the discussion. Here are some themes that came through in their comments.

Patients don’t have the access they need to determine provider quality.

As Reed Mollins of Doctor.com pointed out, “Most of the profiles that perform well on Doctor.com are doctors who have uploaded a profile picture. That’s the level that the consumer is using to make decisions. The average consumer is blind and just relying on a list of in-network providers with silhouettes instead of photos.”

That’s the depth of insight most patients have when thinking about provider quality. Maybe they have a friend or colleague who recommended a knee surgeon or OB-GYN, or maybe they’re just choosing a doctor based on a photo online. Other panelists shared stories of people choosing doctors based on where they went to medical school. It’s scary to think that patients don’t have another way to find out if their doctor is going to do a good job.

Transparency tools and member education is the key to solving this issue. Our experts recommended giving patients access to substantive metrics like hospital re-admission rates, patient outcomes, and even anecdotal reviews. Patients should also understand enough about provider quality to choose wisely when they need a knee replacement or colonoscopy. Patients are able and willing to help control healthcare costs and improve provider quality, and they just need the opportunity to do so.

Providers make referrals without real insight into their colleagues.

It’s not only patients who don’t have insight into provider quality. It’s also other providers.

Have you ever asked your primary care physician for a referral? Say, for example, you have a recurring rash that isn’t responding to over-the-counter creams. You go to your PCP and ask if they can recommend a good dermatologist. How do they determine who to send you to?

You might imagine that they have data on which dermatologists are the most effective and efficient in your area. But they likely don’t. They probably don’t even know if they’re sending you to someone in-network for your plan, or someone who bills your insurance in line with other providers in their specialty.

As Shane Wolverton from Quantros put it, “Even providers who are making referrals have no line of sight to the providers they’re sending referrals to. They have no information to make that decision. Not just the consumers, but the providers are also unaware.”

This is the kind of problem that solid provider quality metrics and transparency tools can easily solve. Your providers should be incentivized and empowered to help you get good quality care at a reasonable price.

Employers, consultants, and payers can demand transparency (and data).

As Marisa Kranz from H-E-B put it, “We don’t want to say, ‘This is the top 40% of providers in the area.’ That’s not good enough. We want to be able to say, ‘This is the provider I would send my loved ones to see.’”

Employers and their advisors are in the best position to influence the state of provider quality data. They can do this by demanding access to data and holding hospital systems accountable. While employers and hospital networks can be on the opposite side of a number of issues, they are united in the goal of improving patient satisfaction. Employers can use this common ground to start conversations around provider quality.

Leah Binder of LeapFrog points out, “You don’t have to be ready to say, ‘I’m going to do all bundled payments’ or ‘I’m going to revamp all my hospital relationships.’ Even if you’re not equipped to do a complete overhaul, you can simply watch the data and make it clear to your providers that you’re doing it. Expect answers and pester. Never stop pestering.”

At Artemis Health, we’re helping our clients do exactly that: watch the data. Though provider quality is hard to measure, we’re working on ways to hold vendors accountable and give employers a holistic view of their benefits data.