Become a Catalyst for a High-Performance Health System

By Karen Davis, PhD, president; and Christine Haran, MA, web editor, The Commonwealth Fund

In the United States, we rely on employers to provide health insurance coverage to 160 million workers and their dependents. Yet few business owners would be satisfied with the performance of the health care system if health insurance were their core business. Spiraling supply costs, variable and inadequate quality, dissatisfied customers, and little or no access for millions of Americans do not spell success.
     As the largest collective purchasers of health insurance, employers can and should drive the fundamental health system reform our country needs, and that Americans want. In launching the Coalition to Advance Health Care Reform, Safeway CEO Steve Burd recently said, "As major employers, we are engaging in one of the most crucial domestic policy debates of our time-fixing our nation´s health care crisis, reducing out-of-control costs and ensuring every American has affordable health care."

What Are the Goals of Health System Reform?
     We need a blueprint that will ensure that the United States has a plan for a health system that performs well across all dimensions of care. It should include:
 •  extending health insurance to all,
 •  promoting effective cost-control strategies,
 •  organizing the system to ensure accessible and coordinated care,
 •  pursuing and raising benchmark levels of high-quality, safe, effective and efficient care,
 •  enhancing the system´s capacity to innovate and improve, and
 •  shaping a coherent set of health care policies through national leadership and public-private collaboration.

Blueprint for a High-Performance Health System
     Extending Coverage. According to a recent Commonwealth Fund survey, two-thirds of employers agree that all employers should share in the cost of health insurance for employees, either by covering their own workers or by contributing to a fund to cover the uninsured.
     Employers who want healthy and productive workers must get involved in shaping state and federal heath coverage legislation. Maine, Massachusetts and Vermont have already passed coverage laws, and California and Pennsylvania are working out proposals. Several bills to extend health insurance coverage to all have been introduced, but they need employer support to move to the top of Congress´ legislative agenda. Some bills would make it possible for employers to purchase coverage through Medicare, while others call for regional health insurance pools that combine employers´ purchasing power.
     Promoting Cost Control. Employers can improve health system efficiency, and save themselves money, by aligning payment for health benefits with accountability and performance through value-based purchasing. Leading employers already are urging the insurers from whom they purchase coverage to support innovative payment methods that reward quality and efficiency. The Partnership for Value-Driven Health Care, a coalition of major employer groups, has several guides that give purchasers specific actions to request from their insurance plans.
     Organizing the Health Care System. Employers can encourage health plans to promote organized care systems that provide accessible, continuous and coordinated care. Making organized care systems the norm in health care delivery is critical to spreading patient-centered care that achieves savings by improving preventive care and better managing chronic diseases. There are a number of resources for purchasers, for example, Bridges to Excellence, a nonprofit that develops reimbursement models that reward health care providers who provide efficient and effective patient-centered care.
     Enhancing Capacity to Innovate and Improve. One way employers can drive innovation is by supporting the creation of a Center for Comparative Effectiveness and Evidence-Based Decision Making. In May, Representatives Tom Allen, D-Maine, and Jo Ann Emerson, R-Mo., introduced legislation to increase federal investment in research to compare medicines and medical treatments.
     Forging Partnerships. By joining with other private and public purchasers, employers can become leaders in the push to transform our health care system. Along the way, employers can take advantage of the many coalitions and resources already at their disposal. In many states, coalitions of stakeholders have formed to advance health system performance, including the Massachusetts Health Quality Partners and the Minnesota Smart-Buy Alliance. Through collaboration, purchasers can streamline administrative costs, improve access and quality, and reform the health care payment system. Taking the initiative now will ultimately prove a "win-win" for U.S. employers and their workers.

The Commonwealth Fund is a private foundation supporting efforts to achieve a high-performing health system for all Americans. Its aim is to promote better access, quality and efficiency, with particular attention to vulnerable groups in society, including low-income people, the uninsured, minority Americans, young children and the elderly. Visit www.commonwealthfund.org for more information about the fund.