Payers See Low Employer Satisfaction, Provide Limited Support

July 28, 2020 - Employers are largely underwhelmed by payer efforts in a variety of areas including value-based care payment reform, resulting in low employer satisfaction rates, according to a survey from The Leapfrog Group.

Employers mostly rated their payer partners at a C on a scale of A to F, which is the equivalent of a 2.57 grade point average.

“The survey should serve as a wake-up call to health plans. Employers are not convinced they are doing all they can to improve quality and cost-effectiveness. Health plans need to be more responsive to employer demands for improvements in health care,” Leah Binder, president and chief executive officer of The Leapfrog Group, said in the press release.

“As a former health benefits executive myself, I’m not surprised that employers said their health plans were less aggressive about quality and transparency than employers preferred,” added Jill Berger, Leapfrog’s director of employee and payor engagement, “This survey brings into focus the conversations employee benefit executives have been having for a long time.”

The survey called on 174 employers, representing about 4 million insured persons, to rate payers on four critical areas. The survey covered responsiveness to employer needs, transparency around employer and employee provider selection, payment reform initiatives that promote high quality care, and value strategies.

READ MORE: Payers Continue to Expand Value-Based Contracting Despite COVID-19

The respondents were evenly split between small and midsize employers and large employers. Almost two-thirds of the employers had employees in more than one state.

In their evaluation of health plan responsiveness, the Leapfrog Group survey invited employers to consider whether health plans understood employer goals and emphasized employee health.

Nearly six out of ten employers (58 percent) found health plans to be responsive. Cigna especially stood out for its prioritization of employee health, receiving a 71 percent approval rating. Aetna was the runner up, with 63 percent approval in this area. UnitedHealthcare and the Blue plans each received 52 percent approval.

Across the board, however, employers did not trust that payers prioritized employer needs over provider preference. Cigna and Aetna were tied but neither of them came close to 50 percent approval.

Employer responses about price and quality transparency were likewise dismal.

READ MORE: Supporting Safety Net Providers Through Value-Based Payments

Just shy of 30 percent of employers felt satisfied with payer transparency regarding hospital comparison. The payer with the highest score for transparency, Aetna, received only 29 percent approval.

Employers did not find that healthcare payers were sharing enough third-party quality of care and safety data.

Cigna scored a 67 percent for offering easy access to cost, quality, and safety data, the highest score in any transparency category. The payer led in every category except for hospital system comparison.

Employers tend to be strong proponents of payment reform toward value-based care models. However, many respondents did not participate in advanced payment models, with only 26 percent saying that they were in one. Of those, 26 percent were satisfied. Another 37 percent turned to models outside of their health plan to contract with providers or contracted directly.

When it comes to driving quality of care, 64 percent of employers stated that this was a priority for payers. But just 52 percent thought that health plans were working with employers to bring down unnecessary healthcare spending.

READ MORE: Payer Fuses Value-Based Care, Support Payments for Small Practices

Again, Cigna achieved a high score in the category of value, hitting 79 percent satisfaction from its employer partners. Meanwhile, UnitedHealthcare received a 52 percent satisfaction rate.

Overall, Cigna walked away with the highest ratings on value. Aetna had the highest scores for quality of care. And at the other end of the spectrum, UnitedHealthcare had the lowest ratings overall.

Small and midsize businesses were less harsh in their scoring compared to larger employers. Cigna has been emphasizing solutions for small businesses lately, having just released data on benefits that are valuable for small businesses. The payer also recently formed a new brand with Oscar Health for small businesses.

“We congratulate Cigna for achieving the highest ratings from their employer clients,” Binder recognized. “But no health plan is earning an ‘A’ from their employer clients for improving health care, and that is disappointing.”

“While employers are favorable toward their health plan in general, most are not satisfied with plans’ performance in galvanizing quality, value and transparency in health care,” the survey stated.

This is the second major survey in the past month to reveal dissatisfaction with payers. A previous JD Power survey showed that members also feel low satisfaction with their health plans when it comes to member engagement, even during the coronavirus pandemic.

“In health care, too often there is confusion about the identity of the customer. So, let this survey reveal it: In the relationship between employers and health plans, employers are the customer, because they pay the bills,” the survey asserted.

"As employers stand for quality of care and demand results for their investment in the health of their employees, they expect their health plan to stand with them and the needs of their employees and their employees’ families. When that fundamental market dynamic is in place, better care and better value can cascade forward.”