The time is now for insurers, employers to stop healthcare’s deadly safety dance

We at Imagine Health would like to commend the National Committee for Quality Assurance for its decision to require health plans to report rates of four healthcare-associated infections (HAIs) at hospitals in their networks, as reported in Modern Healthcare.


Why did a national non-profit dedicated to healthcare safety dance around for this long to finally ask health insurers to be part of the solution to reduce avoidable infections in our nation’s hospitals? It’s also surprising how little health insurers have done on their own – without mandatory reporting requirements – to come to the table to help prevent harm to their members.


Everyone is taking a chance when insurers allow this to happen – unless the insurers and employers who hold the purse strings insist on better performance for their members from our healthcare delivery system.


The goal of the new reporting requirement is to prod health plans into improving quality by putting pressure on hospitals to reduce their HAI incidence. NCQA targeted these four HAIs because they are some of the most common preventable infections in America’s hospitals:


·             Central line-associated bloodstream infections

·             Catheter-associated urinary tract infections

·             Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA)

·             Clostridium difficile intestinal infections. 


This reporting requirement may prompt health insurers to design more tiered networks that incentivize patients to go to higher-quality facilities, or focused networks that exclude hospitals with poor rates of infection. But it won’t happen quickly.


For starters, this requirement doesn’t go into effect until next year. And since health plan networks are forged at least a year in advance, it will be at least two years before health plan underwriters craft new hospital networks based on this crucial safety data.


What’s more, the first year of data will not be reported publicly, because it will be considered a pilot year. In fact, NCQA won’t decide until next year whether the second year of reporting will be made available to the public either. So employers and individuals looking to choose a health plan based on this data won’t get the benefit of this new transparency tool for at least two years.


It’s important to note that the upcoming rule does not rely on any new data or any fancy new algorithms. Health plans subject to the new NCQA requirement – those that use its Healthcare Effectiveness Data and Information Set, or HEDIS – will be using hospital acquired infection data from the Centers for Medicare and Medicaid. These numbers have been available on the Medicare Hospital Compare website since at least 2011, when nearly 722,000 HAIs occurred in U.S. acute-care hospitals, and killed 75,000 patients.


Insurers have long had access to this data, but haven’t, as yet, acted on it. One reason is that insurers have been reluctant to confront doctors and hospitals on safety issues, lest healthcare providers refuse to take their insurance. Insurers, for decades, have wanted to preserve wide networks, at any cost, to provide choice to consumers. Even if – as we now know – some of those choices can be deadly.

The sad truth continues to be that many employers and workers are still paying higher and higher costs without any reasonable expectation of higher quality care. Premiums rose an average of 4 percent in 2015 for employer-sponsored family health plans, according to the Kaiser Family Foundation/Health Research & Education Trust 2015 Employer Health Benefits Survey. Kaiser found that the average cost of that annual family plan premium was $17,545 in 2015 with workers paying, on average, $4,955 towards those premiums.


And so healthcare’s safety dance continues. Employers can sit around and wait for insurers and hospitals to do the right thing. When that fails, businesses can wait for government agencies or non-profit organizations to issue new regulations to spur quality improvements on life-or-death matters such as hospital acquired infections.  


Or employers can stop dancing around the issue and put that $17,545 per worker (actually, $14,036, after saving 20 percent) to work for a network that is explicitly chosen for its safety and quality ratings.


At Imagine Health, we believe that employers can’t afford to wait another two years to excise poorly-performing hospitals from health plan networks. Employers can act right now to offer their employees a high-performance network that doesn’t just incentivize the use of better quality institutions, but requires it.


As this chart of sample markets demonstrates, our proprietary data analytics help us to create networks that include only the best hospitals and doctors, and use volume pricing to deliver plans that are 20 percent less costly than wide-panel, lower-quality PPO plans most employers still offer:

When you’re ready to stop dancing around with the safety of your members, we’re ready to be your partner. We can go where you want to. We’re Imagine Health.



Rick AbbottComment