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» Takeaways for Employers from the Commonwealth Fund’s Report Mirror, Mirror 2021 Report

August 24, 2021

Digital Health, Health Equity, Healthcare Innovation, Healthcare Spending, News, Research

The Commonwealth Fund released their periodic comparison report of various national health systems this month entitled “Mirror, Mirror 2021: Reflecting Poorly.

The report is a series of comparisons performed every 4 years, with prior entries in the series below:

2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

2014: How the U.S. Health Care System Compares Internationally

2010: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update

While every country has a unique mix of policies, delivery systems, and financial models to create its healthcare system, we can still find takeaways from other nations on healthcare policies and structures that contribute to a strong performing system.

The researchers compared 71 performance measures over 5 domains including access to care, care process, administrative efficiency, equity, and health care outcomes.

Unsurprisingly, the United States ranked last overall. This result is disappointing but not surprising because we’ve been aware of our system’s underperformance for years. Despite spending a high amount of per capita GDP on healthcare, our system has been plagued by a lack of access, inefficient administration, and poor health equity and outcomes.

Our interest in the report is as employee health plan consultants, who strive to help businesses deliver higher performing benefits to employees at lower costs.

The key features of top-performing countries for employee health plans to model are to: remove cost barriers, invest in primary care to equitably deliver high-value care, reduce administrative burden, and non-medical support for enrollees.

Remove Cost Barriers to Improve Employee Health

If employees are unable to get the care they need in a way that works for them, they won’t. And employees who defer or avoid care will end up still consuming healthcare, they’ll just do so at a higher cost. Delayed care will show up in claims over time, and as employers are footing the bill, they have a strong incentive to remove barriers for employees to receive care.

Providing a robust telehealth or other first-stop health solution is a great way to reduce the hurdle for an employee to seek care. The foundation of a successful employee health plan is one that delivers the right care to employees at the right place for the right amount.

Educating employees about free preventative care is another key strategy. Despite the ACA introducing no-cost preventative care as an Essential Health Benefit, many employees still wrongly assume that they’ll be billed for an annual check-up with their physician.

Primary Care Systems Make High-Value Care Available and Equitable

Our system is a very reactive health system- we typically seek out care once we are sick or need a condition treated. This leads to high acuity and costly care, compared to developing a relationship with a physician and staying ahead of potential health concerns in the future.

Primary care differs by forming a care team around you and your health, seeking to keep you healthy rather than treat you only once you’ve become sick. Your care team, typically a Primary Care Physician and may also include a Nurse PractitionerPhysical TherapistNutritionistPharmacist, and more. They holistically work together to keep you healthy and treat minor issues that if left untreated, can become more severe to you and costly to treat.

High-performance health plans provide primary care services to employees to invest in their health to keep people healthy, improve long-term outcomes, and thereby reduce costs.

Lower Administrative Burden Unlocks Time and Resources for Other Opportunities

As we discussed previously, administrators for employee health plans should do everything they can to help employees access care. Delayed and deferred care only creates savings in the short-term, while it leads to greater costs and interventions long-term. Employee health plans can also uncover opportunities by offering simplified plan designs to employees, reducing confusion around costs that can delay care.

While more complex cost-sharing strategies may reduce projected costs for an employer, leaders should recognize that employees may forego care rather than incur the risk of a bill or unknown cost to their care. Simple plan designs with just co-pays helps employees know exactly how much it will cost for them to see the doctor. This can get employees in for care, and it keeps them from being distracted with claims and surprise bills.

Additionally, technology resources such as those dealing with transparency and drug fulfillment, to name a few, help employees navigate a complex healthcare system and are viewed favorably. Leaders will want employees to get the care they need at the right price and at the right time, then not be set upon with surprise bills and headaches after the fact.

Non-Medical Social Support for Enrolled Employees

While our municipal, state, and federal governments provide a social safety net for employees, employers can still invest in social services for their employee population in a way that can lead to a healthier population and reduced claims frequency and spending.

Examples include areas such as:

Nutrition: provide healthy food options, cooking classes, and opportunities and resources for active lifestyles

Education: more educated employees can more easily understand connections between their lifestyles and their health

Family & Child Care: Parental leave, flexible hours and remote work conditions

Transportation: Credits for transportation, and adoption of a hybrid work-from-home model, especially given the last year and a half

Adopting Health System Best Practices in an Employee Health Plan

As outlined above, our health system addresses sick care very well but does fall short in a number of ways. As we seek to help employee health plans improve member outcomes and reduce cost burdens, we have to continuously seek new ideas and strategies to accomplish our dual mandate.

Whether we are assessing avoidable mortality measures such as our poor maternal health outcomes, or our high incidence of suicide and other deaths of despair, we need to ask ourselves “How can our health plans support these aims, or are they making them worse?”

By continuously seeking improvement and borrowing ideas that work, employee health plans can do better.

Click here to speak with a consultant about designing a health plan that prioritizes your employee’s health 


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