Final report : : evaluation of tools and metrics to support employer selection of health plans / / Soeren Mattke, Kristin R. Van Busum, Grant Martsolf ; sponsored by the U.S. Department of Labor.

• Author: U.S. Department of Labor,
• VerfasserIn: Mattke, Soeren,; Van Busum, Kristin R.,; Martsolf, Grant,
• TeilnehmendeR: Van Busum, Kristin R.,; Martsolf, Grant,; U.S. Department of Labor,
• Place / Publishing House: Santa Monica, California : : Rand Corporation,, 2014.; ©2014
• Year of Publication: 2014
• Language: English
• Series: Research Report
• Physical Description: 1 online resource (92 p.)
• Notes: Description based upon print version of record.

The Affordable Care Act places strong emphasis on quality of care as a means to improve outcomes for Americans and promote the financial sustainability of our health care system. This report attempts to help employers understand the structural differences between health plans and the performance dimensions along which plans can differ, as well as to educate employers about available tools that can be used to evaluate plan options.

Table of Contents

Cover; Title page; Copyright; Preface; Contents; Figures; Tables; Summary; Acknowledgments; Abbreviations; 1. Introduction; 1.1 Background: The Role of Employers Under the National Quality Strategy; 1.2 Purpose of the Report; 2. Technical Approach; 2.1 Development of Conceptual Framework; 2.2 Environmental Scan; 2.3 Expert Panel Meeting; 2.4 Interviews with Employers and Business Coalition Representatives; 3. Conceptual Framework; 3.1 Understanding the Anatomy of a Health Plan; 3.2 Defining Care Processes for Measurement Purposes; 3.3 Defining Outcomes for Measurement Purposes

3.4 Measuring Quality of Health Care4. Provider-Facing Structural Characteristics of Health Plans; 4.1 Network Management; 4.2 Payment Arrangements; 5. Member-Facing Structural Characteristics of Health Plans; 5.1 Customer Service; 5.2 Cost-Sharing Provisions; 5.3 Care Management; Products and Services for Chronic Condition Management; Products and Services for Curative Care; Products and Services for Health Promotion; 5.4 Evaluation of Member-Facing Characteristics of Health Plans; 6. Process Measures; 6.1 Safe Practices; Definition; State of Measurement Science

6.2 Adherence to Evidence-Based Care GuidelinesDefinition; State of Measurement Science; 6.3 Overuse of Medical Services; Definition; State of Measurement Science; 6.4 Evaluation of Current State of Process Quality Measurement; 7. Outcomes Measures; 7.1 Medical Outcomes; Definition; State of Measurement Science; 7.2 Patient-Centeredness; Definition; State of Measurement Science; 7.3 Efficiency; Definition; State of Measurement Science; 7.4 Evaluation of Current State of Outcomes Measurement; 8. State of Practice in Employer Decisionmaking About Health Plans; 8.1 Information Sources

Decision ToolsEmployer Coalitions; Benefits Consultants; Evaluation of Tools and Resources to Support Employer Decisionmaking; 8.2 Decision Criteria for Health Plan Selection; Cost Is the Primary Driver; Employers Aim to Ensure Network Adequacy; General Reputation of Plans Influences Purchasing Decisions; Quality of a Health Plan Is Rarely Factored Explicitly into Decisions; Quality-Enhancing Products and Services Are Considered Low Priority; 9. Conclusions; 9.1 Current State of Measurement Science; 9.2 Current State of Employer Decision Tools Regarding Quality of Care

9.3 Current State of Employer Decision Process for Quality of Care9.4 Implications for Research Agenda; Appendix A: Description of Summary of Benefits and Coverage and Glossary of Terms; Appendix B: Description of Search Strategies and Tools; Appendix C: Descriptions of Quality Measurement and Reporting Organizations; Appendix D: Descriptions of Quality Measurement and Reporting Organizations; References