There is no doubt that health insurance is complicated. There are co-pays and coinsurance, deductibles and out-of-pocket maximums, in-network and out-of-network providers, and pre-authorization requirements. It can be overwhelming. And at the same time, it is critically important. Not wanting to lose health benefits is the primary reason one out of six workers stay in their job. And when 40% of Americans can’t afford a $400 unexpected expense, having health insurance is essential.
But just having health insurance isn’t enough. With annual premiums for family health coverage at more than $21,000 and workers paying more than $5,500 towards the cost of their coverage, it’s critical that people receive high value care. No one can afford low-value care and the potential for emotional, physical, and financial harm that comes from it. And yet, in Washington state, more than three million people received low-value care at a cost of more than $703 million from 2014 to 2017, according to the Washington Health Alliance’s First, Do No Harm report.
While it may be impossible to know which health plans are providing access to high quality health care in many states, that’s simply not the case here. Since 2008, the Washington Health Alliance has partnered with many of its employer and union trust members to take a hard look at health plan performance by conducting the eValue8™ Request for Information (RFI) process to evaluate health plans. Looking at seven major categories, the RFI asks the plan hundreds of questions, including how it:
- ensures culturally appropriate care is being delivered to members,
- protects members from surprise billing,
- helps members manage chronic conditions, such as coronary artery disease, diabetes, depression, and substance abuse disorders,
- supports shared decision-making between patients and providers, and
- measures provider and hospital performance.
All commercial health plans were invited to participate in the RFI and Aetna, Cigna, Kaiser Permanente Washington HMO and PPO, Premera Blue Cross, and Regence BlueShield each responded. The plans’ responses are analyzed and compared to others across the country, providing a consistent, evidence-based analysis that enables performance to be tracked over time. This year’s eValue8 report provides a summary of the results and Washington health plans not only received the highest score in the nation overall, but in four other areas:
- Kaiser Permanente Washington HMO for best overall, chronic condition management, and helping members manage acute/episodic conditions;
- Kaiser Permanente Washington PPO for provider measurement and management; and
- Regence BlueShield for medical benefit drug management.
This should come as no surprise, though, as many of these health plans have participated in eValue8 every year and have done well compared to others across the country. Looking at performance over time, Aetna, Cigna, and Kaiser Permanente Washington (and its precursor Group Health Cooperative) have all received the highest score in the nation in various categories and others have come close. That illustrates their desire to not just participate, but to use the results to improve the delivery of quality health care in Washington state.
Transparency is the first step towards accountability and that is a key component of improvement. Otherwise, how can you tell when improvements are made? With eValue8 you can, making it possible for those who are making decisions about health insurance plans to ensure they are getting the highest value for their members and their families. It bears mentioning that this would not have happened without the commitment by these Alliance purchasers to embark on this significant undertaking, devoting their time and resources so that we all may better understand health plan quality in Washington state.
Association of Washington Cities, Puget Sound Energy, Bloodworks Northwest, Seattle Chamber of Commerce, Bill and Melinda Gates Foundation, SEIU 775 Health Benefits Trust, City of Kirkland, Sound Health & Wellness Trust, City of Seattle, Sound Transit, Davis Wright Tremaine LLP, Starbucks Coffee Company, King County, The Boeing Company, Pacific Health Coalition, Washington Health Benefit Exchange, Point B, Washington State Health Care Authority, Port of Seattle, Washington Teamsters Welfare Trust
We are certainly better for having these plans willingly participate in eValue8 and we owe them and the purchasers a debt of gratitude for making it happen, but those who are getting higher quality health care are reaping the biggest reward.