DOL Report Helps with Evaluation of Health Plans

March 18, 2014 ( – A new report from the Department of Labor (DOL) describes a conceptual framework of health plan features meant to help employers assess holistic plan quality.

“Final Report: Evaluation of Tools and Metrics to Support Employer Selection of Health Plans” is part of a study to help employers understand the structural differences between health plans and the performance dimensions along which plans can differ, as well as to educate them about tools and resources that can be used to compare plan options.

The DOL found the understanding of what differentiates health plans structurally and how their performance is measured has improved, and tools and resources to help employers use such information are emerging. “In theory, this evolution put employers into a position to select health plans based on quality, but in practice employers are not basing decisions on health plans on those sources of information,” the report says.

Information sources employers use most commonly to inform health plan choices include decision tools that summarize quality information in a user-friendly format, employer coalitions and benefits consultants. All interviewees reported they primarily considered cost of coverage when choosing a health plan. Second only to costs, employers strongly consider network adequacy when choosing health plans.

The DOL review suggests employers rarely base health plan decisions on a comprehensive review of quality. One reason is they find it difficult to understand the more technical domains of quality, such as adherence to evidence-based processes and health outcomes. Employers also struggle to decide how to trade off performance along those domains with performance along more salient and accessible domains, such as member experience, network adequacy and cost.

The DOL report is here.