Tuesday, June 30, 2015

New NBCH Action Brief: Obesity (Update 2015)

More than one-third of U.S. adults and approximately 17% of children and adolescents are obese (a body mass index over 30). Employers must act now to mitigate the cause for overwhelming health care costs and loss of productivity associated with obesity. Employers can play a key role in improving the health and well-being of their workforce.

Read the full Action Brief by clicking on this link.

Thursday, June 25, 2015

King v Burwell Ruling

Today the Supreme Court ruled (6-3) that the federal health insurance subsidies shall remain available to individuals in the 37 states using www.healthcare.gov. This decision means that the major coverage provisions of the Affordable Care Act will proceed as planned. 

Here are links to recent headlines and resources on the topic:

Wednesday, June 17, 2015

NBCH Launches National Risk Solution Purchasing Program

First initiatives focus on significant costs drivers: pharmacy benefits and
musculoskeletal management


WASHINGTON – June 17, 2015 – After payroll, health care benefits are the largest cost for most industries and coupled with the pending excise tax and current reform landscape, it’s more critical than ever for employers to focus on value-based benefits programs to achieve better health at lower costs. To help employers accomplish this, the non-profit National Business Coalition on Health (NBCH) is launching two risk solution programs focusing on pharmacy benefits and musculoskeletal management.

“We’ve focused on two areas that make up a significant share of health care costs,” said Charles Smithers, Interim CEO for NBCH. “By circumventing conventional purchasing/delivery arrangements and focusing on some of the most corrosive aspects of health care costs, we believe we can help employers recover much of this excess, with better health outcomes.”

A partnership has been established with National Employers' Choice Rx. Structured differently than most PBMs, National Employers' Choice Rx is focused on reducing hidden fees, uses an evidence-based formulary based on independent studies, and offers a narrow pharmacy network. In addition to higher quality, a savings of 15-25% with a health care spend reduction of 2-3% is estimated when compared to conventional PBMs.

“We’re committed to this product and the transparency it produces,” said Mike Evans, Director of Benefits at OK Foods Inc. and current National Employers’ Choice Rx client. “There is absolutely no other pharmacy benefit program that can compare in quality and cost savings to employers.”

The second program is with Integrated Mechanical Care, a musculoskeletal management group that uses evidence, analytics, and proprietary guidelines to resolve orthopedic conditions, minimize lost work time, and reduce pain and disability recurrence rates by more than 80%. IMC’s program offers enhanced health outcomes in half the recovery time, with guaranteed savings of at least 25%. Since orthopedic conditions are typically 10% to 20% of the total health spend, employers can realize benefit plan savings of 2.5% to 10%.

These services are available for employers through NBCH’s regional coalition members. NBCH plans to extend these risk solution services to other areas including cardiometabolic care, infusion, dialysis, advanced imaging, ambulatory surgery, large claims audit, high performance networks, and centers of excellence. For additional information or to participate in one of these programs, please contact Sara Hanlon, Vice President, Risk Solutions for NBCH, via email, shanlon@nbch.org.

"While it’s often said that health care is local, purchasers can benefit from national approaches that are value-driven with high expertise,” said Sara Hanlon. “These services can produce better health outcomes and reduce costs significantly, disrupting conventionally excessive care and cost. The real message to purchasers and health care professionals is that there are alternatives that can let purchasers recover the unnecessary costs they have assumed could not be challenged.”

About National Business Coalition on Health
National Business Coalition on Health (NBCH) is a national nonprofit membership organization of purchaser-led health care coalitions, representing more than 7,500 employers, unions and local governments, and approximately 35 million employees and dependents across the United States. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. NBCH seeks to accelerate the nation’s progress toward safe, efficient, high-quality health care and the improved health status of the American population. www.nbch.org
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NBCH Elects New Board Officers

NBCH announced its slate of new officers for the Board of Governors. Officers are elected by their board peers based on proven leadership and commitment to NBCH, as well as their efforts to advance and strengthen value-based purchasing strategies.

Additionally, Charles Smithers, COO for NBCH, was named Interim CEO.

Elected executive committee members include: Chair Karen van Caulil, Florida Health Care Coalition; Vice Chair, Gaye Fortner, HealthCare 21 Business Coalition; Secretary-Treasurer, Marianne Fazen, Dallas-Fort Worth Business Group on Health; and Representatives Larry Boress, Midwest Business Group on Health, and Anne Ladd, Wyoming Business Coalition on Health.

At-Large Representatives newly elected to the NBCH Board of Governors include: Jessica Brooks, Pittsburgh Business Group on Health, and Neil Goldfarb, Greater Philadelphia Business Coalition on Health. Current At-Large Board member Laurel Pickering, Northeast Business Group on Health was re-elected to serve a second term. Cheryl DeMars, The Alliance; Beverly Rossmiller, Tri-State Health Care Coalition; Cheryl Tolbert, Louisiana Business Group on Health; and Christie Travis, Memphis Business Group on Health, will continue their board terms.

“As health care purchasers continue to look for ways to impact the quality and cost of care, NBCH and its member coalitions are playing an increasingly vital role in providing tools and education,” said Karen van Caulil, PhD, President and CEO of the Florida Health Care Coalition. “I look forward to working with my colleagues from across the country to move this agenda forward and also welcome Chuck to his new role of Interim CEO. We appreciate his willingness to assist in NBCH’s transition to new leadership.”

Tuesday, June 9, 2015

Midwest Business Group on Health Releases Annual Employer Survey on Specialty Pharmacy

Today the Midwest Business Group on Health (MBGH) released the results of its fourth annual survey on specialty drug management finding employers are considering unconventional strategies to manage double-digit cost increases while shifting more cost to employees.

Although the vast majority of employers (88%) still rely on traditional plan designs (co-pays and coinsurance), many are ready to focus on new and novel approaches to managing specialty drugs costs.

Survey results indicate a significant number of employers (68%) are considering using a narrow network to manage patients, while less than 10% offer one. In addition, with 16% carving out their specialty drug benefit, 63% are considering moving towards this strategy. The biggest trend, however, is cost shifting. Over half of employers are considering shifting more costs to employees with 18% already doing so. In addition, 43% of the employers who shifted costs over the last three years, increased them by 50% in 2014.

Additional findings are included in the news release and supporting slides which can be found on MBGH’s website.

PopHealth Week Radio Podcast Launched

Last month Gregg Masters (@2healthguru), Fred Goldstein (@fsgoldstein), and Doug Goldstein (@eFuturist) launched PopHealth Week, a weekly radio podcast focused on all things population health.

Broadcast each Wednesday at 12 p.m. Eastern the show features people, topics, news and analysis, presents the broad spectrum of what is and is not population health and how it fits into the changing health and health care landscape.

The website is www.pophealthweek.com.

Tuesday, June 2, 2015

WSJ: More Health-Care Insurers Seek Big Premium Increases

On Monday the Obama administration published more information about hefty premium increases for 2016 sought by large insurers selling plans under the health law.

An article in the Wall Street Journal by Louise Radnofsky and Stephanie Armour reported major carriers from around the country are proposing big increases in the premium rates paid by consumers who buy insurance policies on their own.

Noted in the article which can be found here
Blue Cross and Blue Shield of Illinois is looking to raise rates by averages of 29% or more. In Pennsylvania, Highmark Health Insurance Co. is asking for 30%, according to proposals submitted by insurers for the year ahead. Around the country, some of the main market leaders are looking for double digit increases.
The new requests for premiums come at a time when the political and legal future of the law hangs in the balance. The Supreme Court is set to issue a decision later this month on the validity of the law’s tax credits to offset the cost of premiums for lower-income consumers in most states in the country. 

Wednesday, May 27, 2015

The Commonwealth Fund: The Problem of Underinsured, Rising Deductibles Make It Worse

A new report from The Commonwealth Fund was issued last week finding that 31 million people with health coverage in the United States were underinsured in 2014.

The share of working-age adults who had health insurance all year but were underinsured was statistically unchanged since 2010, after nearly doubling, from 12 percent to 22 percent, between 2003 and 2010. People are considered underinsured if they have had health insurance for a full year, but have high deductibles or out-of-pocket expenses relative to their income.

The study, The Problem of Underinsurance and How Rising Deductibles Will Make It Worse, is based on The Commonwealth Fund’s Biennial Health Insurance survey, which interviewed people 19-64 years old between July and December 2014. It could not separately assess the effects of the Affordable Care Act on underinsurance because people insured all year in the survey had coverage that began prior to the law’s major insurance expansions going into effect.
The rate of growth in medical costs and insurance premiums has slowed in recent years. However, millions of consumers continue to be saddled with high out-of-pocket health care costs. While the number of underinsured people in the United States held constant in 2014, the steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead.
The Affordable Care Act’s coverage expansions and protections have greatly improved the quality of insurance coverage available to people who lack job-based health benefits. In addition, cost-sharing subsidies significantly reduce deductibles for people with low incomes who buy plans in the marketplaces. But those subsidies phase out quickly, leaving families with deductibles that may be high relative to their incomes. In addition, the law has only limited ability to improve the cost protection of employer plans, which is the source of most American’s health insurance. 
Reforms and new approaches are needed to improve the cost protection of health plans. These could include innovations in benefit design that slow growth in deductibles and emphasize incentives that encourage people to utilize, rather than delay, timely health care. In addition, policymakers should identify and address holes in health plans—like out-of-network physicians in in-network hospitals—which are surprising many families with unexpected costs. Finally, systemwide efforts to lower the underlying rate of medical cost growth and share those savings with consumers will be critical.y had coverage that began prior to the law’s major insurance expansions going into effect.

Improving Care for Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a common chronic condition that adversely affects many adults within the working age population, and can be caused or exacerbated by exposure to harmful workplace lung irritants and other environmental factors. These issues may contribute to high insurance costs, lower productivity and increased absenteeism, however, awareness about the risks of COPD is low among patients and employers. 

The National Business Coalition on Health’s (NBCH) Improving Care for COPD Patients grant program, funded by the COPD Foundation, allowed NBCH employer coalition members to educate employers about the clinical and cost impact of COPD and to design interventions to identify and address COPD within their populations. 

This final report summarizing the grantee coalition projects is now available, offering recommendations to help make COPD care improvement a broadly achievable goal for other employer coalition markets.

Friday, May 15, 2015

ACA Compliance: A Blueprint from Employers

ADP, a global provider of human capital management solutions, has developed a useful guide for employers, providing a clear explanation of the ACA's employer compliance requirements, with specific instructions on how to avoid penalties.

The brief offers actionable, practical advice and spells out how employers can adopt strategies to make well-informed decisions. By understanding their available options, employers can not only do right by their employees and save money, but also achieve full compliance with the law.

Information covered includes:
  • Avoiding the “Catastrophic Tax”
  • Avoiding the “Lesser Tax”
  • Conducting an Excise Tax Liability Analysis
  • Documenting the Offer of Coverage
  • Doing Due Diligence on Non-Calendar Year Plan

Thursday, May 7, 2015

Pare and Klepper Commentary -- Specialty drugs: What good is a treatment if it's out of reach?

A commentary by Carolyn Pare, president and CEO of the Minnesota Health Action Group, and Brian Klepper, CEO of the National Business Coalition on Health, was published on Tuesday in the Star Tribune.

The article can be accessed here.
A breakthrough is defined as a sudden, dramatic and important discovery or development. It’s hard to dispute that medical breakthroughs have changed the course of life as we know it. But what good are these breakthroughs if the people who need them can’t afford them? Such is the case with prescription drugs and, in particular, specialty pharmacy.
In the coming years, drug manufacturers will unleash an unprecedented raft of new drugs into the marketplace; some will improve the treatment of common medical problems like high cholesterol and diabetes, while others (those referred to as “specialty” drugs) will be used to treat complex conditions like multiple sclerosis, hepatitis C and cancer. The good news: These “precision therapies” provide new and, in some cases, better treatment options. The bad news: The price tag for such prescription drugs in the U.S. is breathtaking — even scandalous.
Drug companies argue that new products are harder to develop and manufacture, which justifies the additional cost. But U.S. pricing is often three to 10 times that in other developed nations. Is that really acceptable?
Human-resource and benefits leaders from 17 companies who are members of the Minnesota Health Action Group are mobilizing around the specialty-drug-pricing issue by joining a Specialty Pharmacy Care Delivery Learning Network sponsored and led by the Action Group. The goal is to effect market-based change in an informed, united way so Minnesotans can receive the right therapies, in the right place, at the right price and at the right time.
Why should employers care about specialty pharmacy and, furthermore, why should they give their precious time to help drive change? Quite simply, because if they don’t, they will eventually end up paying the price. Don’t believe us? Consider the following:
• The hepatitis C drug Sovaldi made headlines last year when a course of treatment was pegged at $84,000 in the United States, crushing previous cost and use records. The same drug is priced at $900 in Egypt and $51,000 in France.
• U.S. costs for a powerful new cholesterol management drug, PCSK9, are expected to be $7,000 to $12,000 per patient per year, compared with about $1,000 on average for conventional drug therapies. Given the number of patients who might benefit, the market for this one drug could easily reach $100 billion per year, or about 1/33 of what we currently spend on all U.S. health care. All this for a maintenance drug that comes with annual lifelong, recurring costs.
• By 2018, the cost for hundreds of specialty drugs that are flooding the pipeline is expected to account for more than half of the total U.S. drug spend, up from 25 percent in 2006. Spending on this category is growing almost 20 times as fast as non-specialty-drug spending.
Unless something changes, in a few years, we’ll spend more on specialty than nobrian-specialty drugs or, for that matter, on doctors. The likelihood that this trend could financially overwhelm health care purchasers is real.
It’s hard to know how employers and unions will cope with the new pricing. Purchasers should consider a couple of key questions. First, what new measurable value will each new drug bring? This is hardly cynical; one recent study found that cancer drugs approved by the U.S. Food and Drug Administration over the past decade lengthened life by only 2.1 months, on average. Courses of many of these drugs cost more than $100,000. As consumers, we want to know what tangible value we can expect from a purchase. But in health care, that value has proved elusive.
Second, what is the pricing tied to? What makes it more expensive to buy these drugs in the U.S.? Why, exactly, is Gilenya, a multiple-sclerosis drug, almost six times as costly here as it is in Spain?
The battle over specialty-drug pricing could come down to a standoff between drug manufacturers and purchasers. In the past, drug companies have had reason to believe employers and unions were too preoccupied with other matters to take action against specialty-drug costs.
Minnesota Health Action Group members are here to say “enough is enough.” All Minnesota employers should get informed on this issue and join us as we strive to hold drug manufacturers and sellers accountable for rational pricing practices. It’s time, yet again, for business to lead the way in health care innovation.
Benefits managers and financial officers from employers, unions and governmental agencies have been watching their specialty-drug spend and calculating. It’s possible that excessive specialty-drug costs could capsize their benefit plans, making it untenable to maintain good health coverage without severely compromising other important benefits. Just as worrisome, these costs will exacerbate their health care cost burden and cannibalize profits.
Is it possible that, in manufacturers’ zeal for ever-greater profits, specialty-drug pricing could be the straw that breaks the tolerance of the nation’s health care purchasers for excessive health care pricing? If so, maybe health care will finally change.

Dr. Atul Gawande explores why too much medical care is bad for your health, and your budget

Dr. Atul Gawande's article in the New Yorker, Overkill, looks at the problem of over testing, over diagnosis and over treatment in the health system.
“Often, these are fishing expeditions, and since no one is perfectly normal you tend to find a lot of fish. If you look closely and often enough, almost everyone will have a little nodule that can’t completely be explained, a lab result that is a bit off, a heart tracing that doesn’t look quite right.” 
The full article can be found here.

Runaway Drug Prices

On May 5, The New York Times Editorial Board published this commentary, Runaway Drug Prices, examining the industry's arbitrary price increases and a lack of pricing transparency.


Saturday, May 2, 2015

BenefitsPro: Businesses must be solution to health crisis

NBCH CEO Brian Klepper was a keynote at the recent Human Resource Executive Health and Benefits Leadership Conference.

Covering the conference for BenefitsPro, Kathryn Mayer wrote an article summarizing Klepper's comments which can be found here.
Brian Klepper doesn't just think the nation's health care system is flawed; he thinks it's broken.
But the good news, he said, is there is a solution: businesses. 
Klepper urged benefits managers to meet with their C-suite, talk about just how serious the health care problem is, and band together to take action to fight the health care industry and rein in exorbitant costs.
"The most important people in saving health care and saving America is businesses," he said.

Kaiser Family Foundation: American’s opinion of the health care law closely divided

The Kaiser Health Tracking Poll for April found public opinion of the Affordable Care Act (ACA) continues to be almost evenly split, with 43 percent reporting a favorable view and 42 percent reporting an unfavorable view.

Among the key findings, when asked what the next health care priority should be for the White House and Congress, 76 percent of Americans responded "making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them."

Figure 1