By: TAHP | Thursday, September 7, 2023

The big picture: U.S. employers heavily invest in health care, hoping their employees receive the best possible care. Too often, they don’t.

• Morgan Health’s new report shows employers are frequently not getting the quality they pay for and instead found striking disparities in quality among health care providers.
• But the wide variation in care patients receive isn’t just leading to poorer outcomes. It also means higher costs.

Top doctors, better rates: Interestingly, the study indicates that the highest performing doctors deliver superior care often at a more affordable rate.

Breaking it down: Here’s some of what the researchers found:

• Among cardiologists, the performance gap is evident: The top 10% of doctors, judged by clinical evidence, ensured that nearly 75% of their patients with coronary artery disease were on regular statin treatment. Conversely, for the bottom 10%, only 39% of their patients took these life-saving drugs.
• In Texas, the variation in care during pregnancy is also startling: For the top-tier 10% of doctors, only 14% of uncomplicated pregnancies led to C-sections. Shockingly, this rate jumps to 61% for the bottom 10% of doctors.

Why it matters: Most Texans get their health coverage through employers.

• Keeping it affordable is crucial.
• But outdated Texas laws are holding us back.
• At a time when every penny counts, Texas employers are constrained by unnecessary restrictions that prevent them from promoting high-quality health care.

This data drives home a crucial point: Texas employers need to rethink how they evaluate and invest in health care to ensure both quality and value for their employees.

What experts recommend:

1. Equip patients with quality data.
2. Foster an environment where doctors can access and learn from quality data and compare themselves to their peers.
3. Encourage employer-insurer collaborations to form high-value networks that incentivize higher quality, lower cost care.

Case in point: Walmart pays more of their employees’ health costs when they see high-quality clinicians, and as a result, employees have lower out-of-pocket costs. However, Texas employers who rely on health insurance are prohibited from providing these same shopping incentives. Texas needs to reform these outdated laws.

Texas Legislature and the missed opportunities: The Lone Star State, despite its pioneering spirit, missed out last session. Key bills aimed at enhancing health care value failed to pass:

• HB 1073 by Rep. Lacy Hull: Aimed at allowing value-based payments in the private market, emphasizing care quality over quantity.
• HB 3351 by Rep. Caroline Harris: Would have removed transparency barriers, enabling patients to receive more comprehensive quality care data.
• HB 2414 by Rep. James Frank: Would have allowed lower out-of-pocket spending when patients opt for higher quality, lower-cost services.

The bottom line: Employers in Texas aren’t receiving the quality health care they pay for, leading to poorer outcomes and higher costs. While some businesses are looking to innovate, state laws can sometimes stand in the way. For the state’s employers and the Texans who rely on them for health care, it’s not just about dollars and cents. It’s about health and well-being.