Decision-makers Featured

7:00pm EDT March 27, 2003
Choosing a health plan for employees is one of the most important decisions an employer will make. Employees are smarter and better informed than ever, and they expect a plan that meets their needs.

Employers make their company's health plan decisions based on factors, including the amount of premiums, benefits and the size of the network. Just as important, they make decisions based upon quality, although quality is intangible and sometimes difficult to evaluate.

For help, employers can turn to standards for evaluation such as those provided by the National Committee for Quality Assurance (NCQA), a private, not-for-profit organization dedicated to improving the quality of health care throughout the country.

NCQA evaluates health care quality through such things as accreditation, which involves a rigorous on-site review of a health plan's clinical and administrative processes. Another tool is the Health Plan Employer Data and Information Set (HEDIS), a means of measuring a plan's performance in areas such as immunization and mammography screening rates.

Premium amounts alone may not always reflect the true costs -- or benefits -- of quality. Indirect costs, such as productivity, sick days and related wages also must be considered, as many illnesses cost a tremendous amount of money in lost work time.

The NCQA reports that:

* Estimated indirect costs in the United States for asthma total roughly $3.8 billion.

* Major depression costs about $23 billion in lost workdays.

* People with heart disease lose an average of 12 extra days of work and 17.3 bed-disability days each year.

* Smokers are out between two and 5.5 more days each year than are nonsmokers.

Such numbers illustrate why a health plan's commitment to preventive care services can also serve as an important indicator of quality. Effective health plans offer preventive health care initiatives such as:

* Outreach programs to encourage women to have a mammogram screening

* Disease management programs for people with chronic conditions like asthma, diabetes, heart disease and lower back pain

* Beta-blocker initiatives for people who've had an acute myocardial infarction, when deemed medically appropriate for preventing a second heart attack

* Prenatal education programs designed to help women have healthy pregnancies and healthy babies

* Preventive care reminders sent out yearly reminding health plan participants about preventive care services recommended for people in their age and gender group

* Newsletters sent to members with practical information on preventive care

Employers should pay attention to quality, because high-quality plans tend to result in healthier employees. And, as a recent Watson Wyatt report shows, employees place a high priority on quality, too.

Almost 90 percent of consumers surveyed feel that access to quality care is one of the most important factors to consider when choosing a health plan, an increase from a similar report five years earlier.

According to the report, consumers are now more likely to recognize that there are differences in the quality of local health plans, hospitals and specialists.

Fortunately for employers and employees alike, there are solid tools available for judging that quality.

Gregory C. Donnelly is vice president, sales manager, sales division of Cigna HealthCare. Reach him at (216) 642-2573 or at