More on Quality and Safety

Employers give insurers so-so grade in push to drive healthcare quality and value

Cigna received the highest marks for its efforts toward driving for value, while UnitedHealthcare ranked lowest.

Jeff Lagasse, Associate Editor

Employers have graded insurers and health plans on how effectively they direct employees to high-value care in a new Leapfrog Group report released Wednesday. The verdict: not great, but not bad.

Conducted as a confidential online survey, a total of 174 employers nationwide participated, representing an estimated four million insured lives. Survey respondents were executives who administer and fund benefits for employees and dependents. 

Respondents cited their experience with health plans, including Aetna, Cigna and UnitedHealthcare, as well as a range of BlueCross and BlueShield plans, including Anthem and more than a dozen state BCBS plans.

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The survey prompted employers to identify which health plans they partnered with, and rate those plans on four key issues:

  • Responsiveness of the health plan to employer concerns
  • Transparency in helping employers and employees choose the best providers
  • Payment-reform initiatives that incentivize excellence in the market
  • Value strategies driven by health plans

Among the plans reported in the survey, respondents gave Cigna the highest marks for its efforts toward driving for value. Respondents gave UnitedHealthcare the lowest ratings, with the most room for improvement in value, reducing costs and improving quality. Aetna led among plans for putting a focus on quality.


A key finding is that just over half (52%) of employers feel their health plan is on their side in reducing unnecessary healthcare costs. UnitedHealthcare was rated lowest among plans on this factor, with only 43% of their employer clients saying they were satisfied.

Only about a third of employer respondents agreed that their health plans put their needs above those of contracted providers.

Cigna earned the highest ratings for putting a priority on improving the health of employees, with 71% approval from respondents that identified Cigna as their health plan, while UnitedHealthcare and BCBS plans earned the lowest ratings with 52% approval.

Just 29% of respondents are satisfied with how well plans give employees tools to compare hospital systems on quality.

Meanwhile, Aetna achieved the highest ratings for transparency, with 29% approval among employer respondents, while BCBS plans earned the lowest ratings, at 21% satisfaction.

Overall, employer respondents gave their plans a "C" when asked to grade their health plan.  The larger employers were tougher on the plans than the midsize to small employers.


Insurers have played an important role in the national response to the COVID-19 pandemic, since they're covering testing for the virus and treatment for doctor visits.

Aetna recently announced that it is waiving cost-sharing and co-pays for inpatient hospital admissions related to COVID-19.

The Coronavirus Aid, Relief and Economic Security Act, which President Trump signed into law in March, mandates insurers cover preventive services related to coronavirus without cost sharing.


"We congratulate Cigna for achieving the highest ratings from their employer clients," said Leah Binder, president and CEO of the Leapfrog Group, "But no health plan is earning an 'A' from their employer clients for improving healthcare, and that is disappointing.

"The survey should serve as a wake-up call to health plans," she said. "Employers are not convinced they are doing all they can to improve quality and cost-effectiveness. Health plans need to be more responsive to employer demands for improvements in healthcare."

"As a former health benefits executive myself, I'm not surprised that employers said their health plans were less aggressive about quality and transparency than employers preferred," said Jill Berger, Leapfrog's director of employee and payor engagement. "This survey brings into focus the conversations employee benefit executives have been having for a long time."

Twitter: @JELagasse
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