How Employers Can Improve our Healthcare System
By Bill Kramer
Executive Director of National Health Policy
Pacific Business Group on Health
Original Publish Date: November 8, 2016
Employers cover nearly half of the U.S. population, and Medicare and Medicaid cover an additional one-third. Most of the money in the health care system comes from employers, employees and taxpayers. As “purchasers” of health care, employers and government payers want to make sure we’re getting good value for our money.
Historically, however, the purchaser voice has not been as strong as it could or should be. Despite the efforts of many corporate and government leaders, collectively we haven’t pushed for improved value consistently and forcefully. As a result, our health care system continues to deliver inconsistent quality and high costs. One reason for the relatively quiet purchaser voice is the fragmented the purchaser community; we haven’t been working together as much as we could.
A recent Harvard Business Review article stated, “Large Employers Are Key to Reforming Health Care,” as cycles of increasing value are created when purchasers play the lead role in identifying the most efficient and effective providers. If employers can align with Medicare and Medicaid, we can be more effective in driving improved value. Aligning private and public purchasers also sends a clear and consistent message to health plans and providers about what we expect in terms of clinical outcomes, patient-reported outcomes, patient experience and total cost of care.
In response to this opportunity, the Pacific Business Group on Health formed the Purchaser Value Network (PVN), a new nationwide initiative to educate key purchaser sectors – private employers, states, and federal purchasers – on value-based purchasing. Using best practices and lessons learned to accelerate the adoption of value-based payment and care delivery reforms. The network is made up of and for purchasers to accelerate the adoption of high value health care delivery and payment models through policy advocacy, education and purchaser engagement – private employers, states, and federal government – around evidence-based practices.
PVN offers purchasers educational tools and resources that help them understand and implement value-based arrangements for their own population and in their community, including:
- Developing toolkits to provide employers with practical steps to adopt value-based payment models. Each toolkit focuses on specific practical areas, such as improving maternity care, evaluating accountable care organizations (ACOs), managing specialty drug costs and entering into bundled payments for chronic care management.
- Sharing best practices from our partners and other value-based payment pioneers.
- Hosting webinars for employers to understand value-based purchasing through real-world applications currently being deployed out in the field. Recent example: Prescription Drug Costs: Purchasing and Policy Strategies for Employers When Your PBM and Health Plan Aren't Cutting It
- Convening regional meetings with employers and partners with other regional purchaser coalitions.
The Purchaser Value Network’s first initiative focused on maternity and featured a toolkit on reducing unnecessary C-sections, based on the Pacific Business Group on Health’s successful efforts in California. The response from the PVN participants is overwhelmingly positive, with multi-purchaser initiatives launching in several states.
The PVN has been active in the Health Care Payment Learning & Action Network, created in response to the U.S. Department of Health and Human Services’ commitment to moving provider payments from fee-for-service toward alternative payment models that reward quality and efficiency. The network is also working closely with leading health systems and health plans participating in the Health Care Transformation Task Force, an industry consortium committed to moving to value-based payment arrangements. To date, the task force has focused on ACOs, bundled payments and care models for high-needs, high-cost patients.
When employers work together with other health care purchasers to drive improved value in our healthcare system, the results will ultimately benefit consumers and taxpayers. We’ve put up with high costs and inconsistent quality long enough – it’s time to use our influence to demand and achieve better results.
To learn more contact Kristof Stemikis at kstremikis@pbgh.org