OPINIONS ON HEALTH CARE QUALITY AND COST DURING ACA IMPLEMENTATION: RESULTS FROM THREE SURVEYS OF THE AMERICAN PUBLIC AND EMPLOYERS Presented by: Jennifer Benz, Deputy Director of the Associated Press-NORC Center for Public Affairs Research Co-Authors: Nicole Willcoxon, Trevor Tompson, Emily Alvarez, Dan Malato, Becky Reimer, and David Sterrett
Policy Context U.S. spends about 2.5 times more on health care than most other developed countries, but quality isn t any better. Under ACA, government investing in making quality data more transparent and controlling health care costs. Private coverage expanding dramatically under ACA, but not much data on how quality and cost impact health care decisions for the insured. Employers are exploring new benefits designs and adjusting plan offerings to comply with the ACA. 2
Research Objective Among health care consumers and employers: Understand how health care quality is perceived and valued. Measure awareness and use of quality and cost data. Assess how quality and value information impacts health care decision-making. 3
Survey Methods Survey on health care provider quality May 27-June 18, 2014 1,002 interviews with adults age 18 and older RDD with landlines and cell Survey on health care cost and coverage July 22-September 3, 2014 1,004 interviews with privately insured adults age 18-64 RDD with landlines and cell Survey of employers August 19-October 8, 2014 1,061 interviews with employers with at least 3 employees Multi-mode web and phone 4
Section 1: Quality Information Very few consumers are receiving provider quality information. Employers are largely unfamiliar with objective quality metrics. Both consumers and employers instead tend to rely on assessments of quality from known sources such as family and friends or directly from health plans. 5
Finding trustworthy information about provider quality is a challenge for most Americans. Ease of finding information comparing health care quality of providers Don't know, 5% Very difficult, 9% Very easy, 22% Moderately difficult, 16% Neither easy nor difficult, 22% Moderately easy, 26% 6
Percent "yes" among those who have seen information Consumers aren t receiving objective quality data. 70 Percent saying they have seen quality information comparing doctors by source, among those who have seen any information 60 50 40 30 20 10 0 Friends or family Newspaper or magazine Doctor or other health care provider Health insurance company Ratings website Online on a community Online on a government or advocacy group's website website 7
Percent of firms using various sources of quality information among those offering health plans Awareness of objective quality metrics is low among employers too. 80 Data sources used by employers that offer health insurance to evaluate health insurance plan quality 70 60 50 40 30 20 10 0 HEDIS scores or NCQA data CAHPS data evaluat8 Quality data provided by the health insurance plan Yes, uses No, doesn't use Unfamiliar with source Other sources 8
Section 2: Health Care Costs Health care costs are top-of-mind concerns for individuals and employers alike. Even among the privately insured, sizable proportions worry about costs and make health care decisions based on costs. Employers also worry about the bottom line, for themselves and their employees, when selecting plans. 9
Percent privately insured Americans age 18-64 Even among the privately insured, people worry about health care costs. 90 Concern about being able to afford specific health care expenses under current health insurance plan 80 70 60 50 40 30 20 10 0 Major surgery or care for lifethreatening illness To keep health insurance Emergency room visits or urgent care Prescription drugs Regular checkups or exams A great deal/quite a bit concerned Only a little/not at all concerned 10
And even with private insurance, people make health care decisions based on costs. Percent of privately insured who have done the following behaviors at least once since enrolling in health insurance plan Did not go to the doctor when sick or injured % All privately insured age 18-64 19 % Highdeductible plan % No highdeductible plan 29* 15 Went without a routine physical or other preventive care 18 24* 14 Chose a lower cost option for recommended test or treatment 17 23* 14 Skipped a recommended medical test or treatment 17 23* 15 Did not fill a prescription or took less than the prescribed dose of medicine 15 18 13 Went to an urgent care clinic instead of a primary care doctor 15 23* 10 Changed doctor or other health care provider 12 9 13 Went to an emergency room instead of a primary care doctor 12 13 11 Went without mental health care when needed 7 8 6 11
Employers place a high importance on the bottom line. The importance of several factors employers offering health insurance plans consider when choosing which plans to offer The cost of the plan to your organization The type of services covered under the plan The cost of the premium for employees The level of service provided by the plan to your organization The amount of the deductible and outof-pocket costs for employees How broad or narrow the provider network is The reputation of the health insurance plan with other companies Quality ratings of providers covered by the plan The accuracy and timeliness of claims processing Ensuring continuity in plan offerings to employees The geographic coverage of the health care network Broker recommendations Employee feedback on current health care plans and coverage The accreditation by national organizations Employee preferences 0 10 20 30 40 50 60 70 80 90 100 Percent very or extremely important 12
Section 3: The Connection between Health Care Quality and Cost The relationship isn t crystal clear for most consumers or employers. Perceptions of needing to pay more for high quality. But many don t want to sacrifice quality just for cost savings. 13
Americans divided on whether high-quality health care comes at a higher cost. Relationship between higher-quality care and higher cost Relationship between lower-quality health care and lower cost Depends, 4% Neither, 1% Don't know, 10% No real relationship, 37% Higher-quality care comes at a higher cost, 48% Neither, 1% Depends, 8% Don't know, 13% No real relationship, 48% Lower-quality care comes at a lower cost, 30% 14
For employers, cost and quality is a fine balance. How likely would your organization be to accept lower quality ratings in order to save money for both your organization and its employees? How likely would your organization be to pay more for a health care plan with higher quality ratings? Extremely or very likely 10% Extremely or very likely 11% Not too or not likely at all 63% Somewhat likely 27% Not too or not likely at all 45% Somewhat likely 44% 15
Discussion & Implications Work to be done in raising awareness/use of existing quality metrics and in building public trust for forthcoming metrics. Need to disentangle the perception that high quality = high cost. There are important subgroups to examine as coverage expands. There will still be some people for whom cost remains a barrier to care. Both consumers with and employers offering HDHPs differ in terms of the relative import of cost and quality based decisions. 16
Thank you! The AP-NORC Center for Public Affairs Research taps into the power of social science research and the highest quality journalism to bring key information to people across the nation and throughout the world. www.apnorc.org 2015 The Associated Press-NORC Center for Public Affairs Research 17