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Employers to Health Plans: 'Quality Comes First'

Analysis  |  By Laura Beerman  
   February 06, 2023

Leapfrog reports that employers want more quality and transparency.

The Leapfrog Group has released its latest report on employer-health plan sentiment and the results are less than stellar.

The report—Are Employers Satisfied that Health Plans Drive Quality, Safety, and Value?—is based on a survey from the independent national watchdog organization in which employers rate their health plans on:

  • responsiveness to employer concerns
  • provider choice transparency for companies and their employees
  • market-based payment reform quality initiatives
  • value strategies

The 2022 survey responses came from more than 100 U.S. small, midsize, and large employers covering from 10,000–100,000 lives each. More than one in four respondents employed staff in 21 or more states. The 174 respondents included HR directors/managers (49%), HR senior executives (14%) and CEO/CFOs (11%). Respondents cited their experience with health plans including Aetna, Cigna, UnitedHealthcare, and BlueCross and BlueShield plans.

Quality is job one

The Leapfrog report stated: "Most notably, the survey findings suggest that when evaluating health plans, employers prioritize quality in care over other factors."

The report added: [W]hile employers generally believe health plans are aiming for quality and value, employers perceive significant room for improvement across all categories surveyed."

In a press release for the report, Leapfrog president and CEO Leah Binder stated: "We were a little surprised at how clearly the findings showed that employers care first and foremost about quality of care. They want results. The report points to specific issues that appear to disappoint employers and what successful health plans do to earn their trust."

Room for improvement: data and value

Leapfrog surveyed employer opinions on the safety, quality, and value of their health plan, with the corresponding report noting: "Most employers agreed their health plan cares about quality (57%), is committed to reducing unnecessary health costs (53%), gives employees easy access to usable data (59%), and demonstrates a commitment to employee health (56%)."

Health plans came up short on employer favorability in two major areas: sharing of quality and safety data (helping members choose the best providers for them) and alternative payment model offerings (steering members to the best providers).

"It is critical that health plans improve transparency of data," noted Binder in the release.

These results were mixed in comparison to 2020.

"While employers were more likely to agree that their health plan shares quality and safety data in 2022 than in 2020," the report noted, "employer satisfaction with alternative payment model offerings appeared to decline in the two years between survey" (from 41% to 30%).

It's quite possible that the pandemic's impact on data and collection and reporting contributed to the decline.

Correlating results to health plan grades and GPAs

The Leapfrog survey asked respondents to also grade their health plans based on their ability to provide their employees with high-quality care. The result? An overall "C" grade, with considerable variation between plans. This corresponds to an average health plan "GPA" of 2.29, a decrease from 2.57 in 2020.

For employers that gave their health plans the highest grades, the results echoed other response percentages. First was the belief that their plan cared about employees' quality of care (89%). Second was plan ability to improve employee health (84%). Health plans that received high grades offered employees easy access to usable data (79%), were committed to reducing unnecessary health costs (76%), and supplied provider quality data (74%).

Implications for employers

These results suggest that employers remain disappointed in many aspects of health plan performance—and at a critical time. As part of the 2020 Consolidated Appropriations Act, which updated the Employee Retirement Income Security Act, employers are on a greater legal hook for delivering high-quality, cost-effective employee health benefits.  

With this new accountability comes new employer concerns.

As HealthLeaders reported in September 2022, the Purchaser Business Group on Health (PBGH) debuted new strategic goals to "redirect" member spend and purchasing toward affordable, whole-person, equitable care.

PBGH, which includes nearly 40 large public and private employers, will also launch a Public Purchaser Advisory Committee to "elevate the needs of public members and help further integrate the work of public and private purchasers." In its press release, PBGH noted that its members are "frustrated by uneven quality and out-of-control spending" and that some 90% of large corporate executives "believe the cost of providing health benefits will become unsustainable" within five to 10 years.

An April 2021 survey from PBGH, the Kaiser Family Foundation, and West Health Institute revealed that some 85% "expect the government will be required to intervene to provide coverage and contain costs."

A roadmap for health plans

Leapfrog noted that "dissatisfaction in this report should be an urgent priority for health plans," providing "a road map on how to increase satisfaction with employers and purchasers." Leapfrog identifies quality as a "competitive opportunity for health plans … [which] should look for opportunities to partner with business groups on health and employers and other purchasers to better achieve these shared goals."

Laura Beerman is a contributing writer for HealthLeaders.


Employers want their health plans to deliver value by focusing on quality and improving health data-sharing and transparency.

These are the topline results from Leapfrog's latest report.

Leapfrog's analysis is based on findings from a confidential survey of company executives that administer and fund benefits for employees and their dependents.

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