A Customized Approach
There is no one-size-fits-all solution for engaging employers in initiatives designed to derive greater value from the health care system. Alliances have found employer engagement to be difficult and time-consuming work. Above all else, a successful employer engagement strategy is one that is tailored to the needs of each employer and results in employers working jointly with providers, health plans, and consumers to improve quality and value. Employers are not a monolithic group, and they vary considerably in their understanding of the issues and their ability to use their purchasing power to drive change in the health care market. Market dynamics are also at play that affect how much negotiating strength employers have in pushing for change. For example, health plans often have the upper hand in a market that has one dominant plan compared to a more competitive marketplace. Similarly, employers and health plans may have a hard time negotiating favorable pricing in a highly consolidated provider market. A successful strategy in one community, therefore, may not be effective in another. Employer characteristics affect how employers respond to market dynamics. For example, large employers may have more market influence but also may have a geographically dispersed population of covered lives, making locally driven market reforms less of a priority. There are also differences in how employers interact with the health care system. Some negotiate with health plans about their coverage or benefit decisions, others work through agents and brokers, and some are in regular, direct communication with leaders in hospitals or medical groups. These differences all influence the degree to which an employer has (or perceives to have) control over health care costs and quality.
So, while an Alliance may experience pockets of active purchasing at the individual employer level, capacity and readiness to act fall along a broad continuum. Activities along the continuum range from working with employees to increasing awareness of variations in health care quality, to participating in Alliance events or activities, to moving to value-based purchasing. Alliances have found it necessary to meet employers where they are with a customized approach that complements strategies employers arealready implementing, provides a value proposition that is compelling to that employer, and is realistic given the resources the employer is willing to invest.
Employer engagement in Aligning Forces, therefore, has been an iterative process. Once engaged in the work of the Alliance, employers generally move along a continuum as they strive to control costs and improve quality. Each step along the continuum requires increasing commitment and resources on the part of the employer and increasing engagement of external stakeholders (such as providers, health plans, and brokers). The activities employers engage in also have a more direct link to improved quality and reduced cost as they move along the continuum.
 Aligning Forces for Quality. (2012). “Bullish on Business: Engaging Employers in Health Care.” http://forces4quality.org/lessons-learned-engaging-employers-health-care.
 Strategic Guidance: Practical Approaches for Engaging Employers in Community Alliances. AIR, in process.