Maintaining employer engagement in the absence of a quantifiable return on investment is difficult. In many Alliances, employers did not have a well-defined role at the start of the program. Participation was often limited to sitting on the leadership team and providing strategic guidance or serving as a communication vehicle to reach employees. In many cases, this was because communities had limited information on quality and cost, and initial efforts focused on building capacity for data collection, performance measurement, and public reporting; value-based purchasing necessarily had to follow these efforts. While these activities were important to building a foundation of multi-stakeholder support and educating employees about being informed consumers, often they did not align with existing employer initiatives, nor did they have a direct impact on employers’ healthcare costs.
Once information on healthcare quality, cost, and utilization was available, Alliances began looking to employers to support quality improvement and payment reform efforts and to use their market leverage to pressure health plans to support these efforts. But many Alliances had a difficult time convincing employers of the value proposition and could not guarantee the efforts would have a positive impact on costs and quality. Many communities had a hard time keeping employers at the table, let alone motivating them to invest in new initiatives.
The exception to this was found among Alliances that were able to offer employers something tangible in exchange for their time and resources that they do not have access to elsewhere: data. Data quantifying the quality and cost of the healthcare employers purchase was attractive to employers and demonstrated opportunities for improving value.
Data on quality, cost, and utilization is necessary to motivate change. Most employers have access to at least some data, such as absenteeism, pharmacy data from a pharmacy benefit manager, health care utilization, or health care cost data. However, few employers have the capacity to combine these various data streams to provide a complete picture of health care quality and value that is actionable. Further, looking at these data streams in isolation can give a distorted picture and limits employers’ ability to compare their costs and benefit offerings with other local employers. Alliances that gave employers access to information on the quality and cost of healthcare they purchase—and local benchmarks—have been more successful in getting employers to the table and keeping them there. These data can help inform benefit design, cost-sharing arrangements, and network makeup and can help identify “high-value” targets for improved quality and value. Additionally, these data can help quantify potential savings.