How Public Employee Health Plans Use Their Clout to Improve Quality
<p>Because they are responsible for a large share of health care purchasing in every state, public employee health plans have the leverage to spur participating insurers and provider groups to take part in quality improvement, cost-containment, and related initiatives.<br><br>The new Commonwealth Fund report <a href="/publications/fund-reports/2008/jan/what-public-employee-health-plans-can-do-to-improve-health-care-quality--examples-from-the-states
">What Public Employee Health Plans Can Do to Improve Health Care Quality: Examples from the States</a> is designed to help state public employee health plans and other large purchasers make strategic decisions about developing or coordinating quality improvement initiatives. Analysts with the Lewin Group describe programs around the country aimed at promoting provider adherence to clinical guidelines and best practices, publicly disseminating provider performance information, and implementing performance-based incentives, among other goals.<br><br>For example:<table border="0" cellpadding="3" cellspacing="0"><tr><td class="first"><ul><li>The Minnesota State Employee Group Insurance Program provides consumers and providers with a Web-based resource to compare quality-related performance across health care clinics serving three-quarters of the state's population. Patient experiences are compared in 10 treatment areas, from immunizations to care for chronic conditions like heart disease and diabetes.</li><li>The North Carolina State Health Plan recently launched a healthy living initiative called HealthSmart for its 615,000 members. One of its features is an Internet-based personal health portal through which members can take a health risk assessment and receive a customized personal action plan, health-coaching services, worksite wellness programs, and information.</li></ul></td></tr></table>PEHPs can combine their quality improvement activities and strategies with other large public and private sector purchasers, including Medicaid and employer groups, the authors note. The extra leverage gained from such coalitions can enhance PEHPs' purchasing advantage and the coordination of state-level quality promotion activities.<br><br>Read the report to learn more about these and many other innovations, and about how PEHPs and other purchasers can mix and match strategies to achieve their quality improvement goals.</p>