Employers fund huge swaths of the healthcare system, yet the quality of care their employees receive varies widely. A new analysis from Morgan Health aims to arm companies with strategies to drive better quality.
The study, conducted in conjunction with Morgan Health's portfolio company Embold Health, found that across the top 10% of providers, 73% of patients with coronary artery disease are taking the recommended statin medication per guidelines on average.
By comparison, that drops to 39% on average for patients treated by the bottom 10% of providers, according to the study.
Similarly, the study identified significant contrast in outcomes for cesarean sections between these provider groups. On average, patients treated by a doctor with top quality ratings saw a 14% C-section rate for uncomplicated pregnancies. Meanwhile, that rate was 61% for patients treated by doctors in the bottom quality tier.
This wide variance in quality is despite the fact that employers shell out $1 trillion in annual healthcare spending, providing coverage to about 180 million people across the U.S.
"Really, our big takeaway is just that employers are spending over a trillion dollars annually on healthcare for their employees, and most understandably so believe that they're buying a really high quality healthcare experience for their employees and those families," Katherine Bobroske, Ph.D., vice president of healthcare innovation and data science at Morgan Health and one of the study's authors, told Fierce Healthcare.
"But the data that we're finding is kind of painting a very different picture—in particular, that there's a lot of quality and provider variation within employer-sponsored insurance," Bobroske said.
And employer spending on healthcare is only continuing to rise. The average annual premium for family coverage was $22,463 in 2022, which is an increase of 20% over the prior five years and 43% over the past decade.
However, the study said that if employers collect and deploy provider-level quality data for their membership, they can drive significant quality improvement.
For example, Microsoft teamed with Embold to launch a provider search tool that allows members to better identify high-quality primary care and specialty providers who can meet their individual needs. Though the tool is still in early days, the study said that initial feedback does suggest employees who used it were more likely to swap to a high-quality provider.
Retail giant Walmart worked with Embold on a similar initiative that took it a step further, offering coverage for a higher share of eligible costs in their medical plan when workers select a preferred provider with high quality ratings, according to the study. And, much like for Microsoft, initial results indicate that the program is leading more patients to seek care from quality providers.
Bobroske said there are a couple of key steps employers can take if they want to follow a similar path. Step one is putting performance data in the hands of the member, empowering them to take a greater role in their care. Then, providers need a more clear look into their own performance metrics.
Employers should also use these data to work with their insurance carriers to develop higher quality provider networks, she said.
She said, though, that ultimately the study suggests that while employers can take a leading role in driving healthcare transformation, that push is in its nascent stages.
"Even the kind of big employers who are really investing in to employer sponsored insurance and seeing this as an investment into their employees and their families, they're still at the very early stages of being able to drive big change in the industry," Bobroske said.