Quality is something that consumers look for in almost every purchase they make. That includes both health care and health insurance.
But trying to define what quality means in terms of health insurance and what quality should mean to an employer trying to make choices for his or her company’s health coverage is not an easy thing to do.
“There are many aspects of health care quality and health insurance, but the simplest way to define quality in health insurance terms would be access to quality care,” says Sandra McAnallen, the vice president of network and provider relations for UPMC Health Plan. “Providing that access is what helps people to get the right care in the right place and at the right time as well as providing them with an excellent experience in terms of member service.”
Smart Business spoke with McAnallen about understanding what quality means in health insurance terms and its importance to employers.
How can an employer determine quality in health insurance plans?
Quality is a difficult thing to measure accurately, but there are certain measures that employers should look for and specific questions an employer can ask to determine if a health plan can deliver it.
For instance, for any health insurance plan you are considering, you need to research that plan’s network of hospitals and physicians for broader geographic coverage and specialty services. In many instances, a health plan’s directory of providers is available online.
A second thing to look for is accreditation. An accredited provider organization such as a hospital or a health plan is one that has met the standards of an independent organization. There are many national organizations that review and accredit health insurance plans and institutions. For hospitals, the Joint Commission accredits and certifies more than 18,000 health care organizations and programs in the U.S. Accreditation and certification from the Joint Commission is given to organizations that meet certain performance standards. The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization that regularly measures the quality of care delivered by the nation’s health plans.
