Assessing Quality-Based Benefit Design

By PricewaterhouseCoopers

This is archived content; for historical reference only.

Skyrocketing health benefit costs are getting a lot of attention, and efforts to rein in those costs often overshadow the importance of designing benefit packages that foster high-quality care and outcomes. Yet high-quality care not only helps employers attract and retain employees, but also enables companies and their workers to squeeze more value out of each health care dollar they spend.

Quality-based benefit packages take traditional benefit design one step further by emphasizing coordination of health care, availability of support services, and the importance of providing useful information to consumers. But are they effective? And do they really improve the quality of care and boost the value of benefit dollars?

This paper attempts to answer these questions by reviewing and scoring health benefits research, academic literature, and major health-related publications. It focuses on six quality-based benefit design strategies intended to increase the net value of health care spending:

  • Health plan options, eligibility, and premium contributions;
  • Provider selection and differentiation of provider performance;
  • Inpatient and outpatient benefit design;
  • Pharmacy benefit design;
  • Health promotion/risk reduction and chronic care management; and
  • Availability of price and quality information to health care consumers.

Overall, the paper found only partial evidence in support of quality-based benefit design strategies and limited evidence of return on investment for such tactics.

An executive summary of the paper’s findings is provided under Document Downloads, along with the full report and bibliography.