Low-quality health care is costing employers big
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Illustration: Sarah Grillo/Axios
U.S. companies are spending big on employees' health, often with little insight into whether they're paying for quality care.
Why it matters: Whether patients are given and stick with the best documented course of care — such as statins for heart disease — can have everything to do with what doctor they go to.
- But the wide variation in care patients receive isn't just leading to poorer outcomes. It's also also pricey to employers, who have seen health costs soar without necessarily getting a good return on that investment, according to a new report from JPMorgan Chase's health care arm Morgan Health.
What they're saying: "Employers are spending over a trillion dollars annually on health care for their employees and, understandably so, many of them believe that they're buying a high-quality health care experience," Katherine Bobroske, vice president of health care innovation and data science at Morgan Health, told Axios.
- "But what we're finding is that the data in terms of quality and provider variation within employer-sponsored insurance are painting a very different picture."
Zoom in: Working with Embold Health, which is one of Morgan's portfolio companies, they noted multiple examples of this phenomenon in a database of roughly 110 million commercial medical and pharmacy claims.
- In the example of statins, which have been a guideline-recommended therapy for years, 37% of patients with coronary artery disease seeing the bottom 10% of performing cardiologists adhered to the therapy, per the report, which was published in New England Journal of Medicine Catalyst.
- On the flip side, 73% of patients who saw the top 10% of performing doctors adhered to the cholesterol-lowering drug therapy.
- In another example, while clinical guidelines discourage inappropriate cesarean sections due to increased risks, more than 60% of women with uncomplicated pregnancies who were seeing the lowest-performing obstetricians delivered their babies through the procedure.
- Roughly 14% with uncomplicated pregnancies received a C-section among those seeing obstetricians who were in the top 10% of performers.
The bottom line: The researchers recommend employers put provider quality data in the hands of plan members and support an ecosystem where clinicians themselves can see the data and make improvements.
- They also recommended employers work directly with insurers using provider-quality data to create higher-quality networks.
- For example, they highlighted Walmart's decision to pay a higher share of workers' health costs when they see clinicians the company identified as high quality.
