Benefits Consulting

Plan sponsors that offer health maintenance organizations (HMOs), preferred provider organizations (PPOs) and/or point-of-service (POS) plans have worked hard to assure that those managed care organizations (MCOs) are reasonably priced and have networks of health care providers located where participants live and work. Frequently, however, MCOs look very similar. Their services and costs can be comparable. There is often significant overlap in their provider networks. For plan sponsors that are looking for a way to differentiate among MCOs, quality is an important criteria.

Sibson Consulting has developed a method to assess the quality of health care delivered by MCOs: Quality Valuation (Q-Val ^SM). Q-Val is a customized program that analyzes the degree to which an MCO oversees and assures the delivery of quality health care to its members. HMOs, PPOs and POS plans can all be evaluated using Q-Val.

Q-Val addresses 20 different quality factors and gives each plan sponsor the opportunity to select which of the 20 factors are most important to its plan participants. Examples of the 20 quality factors include: disease management, enrollee satisfaction, member services, centers of excellence, pediatric services and women’s services.

Q-Val determines, through carefully crafted questions, how MCOs manage and monitor the quality of care provided to participants by their contracted health care providers. Q-Val performs a quantitative analysis of the relative value of an MCO compared with other MCOs. Q-Val identifies for plan sponsors the MCOs that can best meet the needs of their participants.

Q-Val is unique. Its characteristics include:

• Customization Plan sponsors rank the quality issues most important to them.
• Differentiation Q-Val examines MCOs that appear to be similar and highlights their differences.
• Easy Interpretation Q-Val reports include quantitative MCO scores and can compare one MCO to another or to all MCOs and to a benchmark.
• Flexibility Q-Val can compare HMO, PPO and POS plan designs for fully insured or self-funded plan sponsors. Q-Val can evaluate all plans, including those that are not accredited by the National Committee for Quality Assurance (NCQA) and/or those that do not publish their Health Plan Employer Data and Information Set (HEDIS).

Q-Val results can be presented in a “Report Card” format that plan sponsors can distribute to participants during open or new employee enrollment to help demonstrate not only the cost and network capabilities of the managed care organization(s) being offered, but those MCOs’ quality oversight capabilities.

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