Employee Health Plans: Beyond Kicking the Tires

Andrea Walsh, executive vice president and chief marketing officer of HealthPartners, says eValue8 is creating a new transparency in performance data that’s driving quality improvement across the market. “It allows employers to get under the hood and find out what a health plan is really doing to improve quality in key performance areas, and the comparative scores can spur real change in the plans,” she says. HealthPartners saw an increasing number of employers use eValue8 scores to assess its performance in 2005, Walsh says.

But others believe eValue8 has limitations that will need to be addressed if it’s to achieve broader acceptance in the market. MaryAnn Stump, vice president of strategic and consumer innovation for Blue Cross and Blue Shield of Minnesota, says a major drawback is the apple-to-apples comparisons drawn between HMOs and PPOs (preferred provider organizations) in the survey. “It’s like trying to compare AM and FM radio stations,” Stump says. “EValue8 was originally developed as a tool to assess HMO performance, but it’s now being applied as a one-size-fits-all evaluation device without the proper modifications.” Evaluating the more contained structure of an HMO will offer significantly different results from the assessment of a PPO, which is more loosely organized, she says.

Matching Strengths to Needs

Others have questioned why eValue8 doesn’t provide aggregate scores for health plans completing the survey—say a 90 for one plan, 80 for another—rather than offering comparative rankings only in individual performance categories, such as information technology or pharmacy management.

BHCAG’s Pare replies that providing an overall score would run contrary to the tool’s purpose. “There is a danger in simplifying scoring too much, because it becomes harder for people to see those specific categories where a plan is performing well and where it is not,” she says.

Indeed, employers say the ability to match a health plan’s strengths with their areas of greatest need is one of the biggest attractions of eValue8. Montreuil of Carlson Companies says he’s most interested in plans that grade out high in chronic disease management (helping patients with conditions such as asthma, cardiovascular disease, and diabetes) as well as in consumer engagement and support (the ease with which employees can get access to doctors, nurses, and clinical services.) But because Carlson uses an independent pharmacy benefits manager, scores in the pharmaceutical management category aren’t as critical to him.

Carlson Companies has used Patient Choice as its health insurer since 1997, but Montreuil says the emergence of eValue8 prompted him to examine his health plan options for the first time in eight years. After a thorough review of all the relevant factors, Carlson opted to remain with Patient Choice, but Montreuil says using eValue8 was a valuable “level setting” exercise that helped confirm how well his plan stacked up to the competition.