PBGH Impact Report

• Hospital Price Transparency regulations requiring hospitals to provide consumer-facing information on “shoppable” services, as well as purchaser-facing information on standard charges and negotiated prices on all services took effect on Jan. 1, 2021. So far, however, many hospitals have not fully complied with the regulations.

• In a meeting with White House staff in late June 2021, PBGH strongly recommended increasing the penalties for non-compliance of the transparency rule. Shortly thereafter, the Administration published an update to the regulation in which they accepted our recommendation.

• PBGH successfully influenced the two sets of proposed regulations issued by federal agencies on implementing the No Surprises Act, which will take effect on January 1, 2022.

• The draft rules for the “qualified payment amount” and the arbitration process are in line with PBGH recommendations.

PBGH has actively promoted legislative and administrative action for many years to address the problem of industry consolidation and market power that costs companies and their employees:

• PBGH brought employers and unions together with California’s Attorney General to successfully file a class action suit against Sutter Health’s use of market power and monopolistic business practices that cost employers and employees. The result is a $575 million settlement. This has been a 10-year effort by PBGH that was settled December 2019.

• President Biden’s recent Executive Order on Competition in the American Economy included many PBGH recommendations for stronger anti-trust enforcement by the FTC and for prohibitions on anti-competitive practices by hospitals, health systems and drug companies.

• PBGH played a major role in the design of the proposed California Office of Health Care Affordability (OHCA) for which funding was included in the state’s budget, and PBGH will pursue legislation to help enable OHCA in the 2022 session.

• Three of California’s largest health care purchasers – Covered California, California Public Employees’ Retirement System and the City and County of San Francisco – are contractually requiring their health plans to adopt a set of quality measures developed by PBGH’s California Quality Collaborative (CQC) to support enhanced payments for advanced primary care for the 2022 plan year. This marks the first time purchasers in California are aligned on primary care expectations for health plans.

• In addition, the measures have also been adopted by California Health Care Foundation and Blue Shield of California.

• Increasing accountability for mental health screening and treatment in primary care is a central attribute of advanced primary care. CQC has developed tools to help primary care organizations to better integrate behavioral health into care deliver.

• PBGH has been invited by the head of the Center of Medicare and Medicaid Innovation (CMMI) to work with the agency closely on employer-centric health care reform recommendations.

• The PBGH National Primary Care Payment Reform work group, an employer/purchaser-led initiative in support of advanced primary care used the quality measures developed by CQC to create model contract language. Together the group drafted and came to agreement on a common purchasing agreement.

• PBGH, in partnership with The Boeing Company, brought together more than 175 employers, public purchasers, health plans, providers and other stakeholders to advance common priorities for innovative primary care payment reform using the model contract language created in the PBGH Primary Care Payment Reform work group.

• The first alliance of its kind between a national employer organization and a regional coalition, PBGH and The Colorado Purchasing Alliance (TCPA) signed an agreement to jointly contract directly with centers of excellence across Colorado.

• With PBGH’s measurement expertise, we are able to identify the highest quality providers. Together with TCPA, this will allow us to bring employers together to purchase care directly from those providers.

• PBGH worked with one of Southern California’s largest employer purchasers and its health plan and service delivery partners to successfully implement the country’s first comprehensive and innovative maternity clinical episode payment model including prenatal care, labor and delivery and six months of postpartum care. In addition to utilizing a rare prospective payment model, the program includes innovative focus areas, maternal mental health and use of midwives, for measurement and quality improvement. Hospital data show improvement on quality measures for the overall population served.

• With support from PBGH experts, several PBGH members now provide benefits for doulas, which supplement routine prenatal care for women by providing social and emotional support, individualized and culturally specific education and strategies to reduce stress and other barriers to healthy pregnancies. Doulas can be particularly beneficial for women of color and women from low-income and underserved communities. They help reduce health disparities by ensuring that pregnant people who face the greatest risks have the added support they need.

• PBGH created a telehealth experience measurement survey with the goal of improving patient experience and quality As adoption of new digital health and telecommunication platforms increased, PBGH created a telehealth experience measurement survey which has informed the improvement of telehealth care delivery by providers and payers.

• With technical assistance from PBGH’s CQC, primary care teams in California were able to improve access to care and chronic disease management for more than 720,000 Californians with diabetes and asthma through telehealth services, such as remote patient monitoring.

• Elizabeth Mitchell, president and CEO, gave testimony to the House Committee on Energy & Commerce, Subcommittee on Health and shared the large employers’ perspective on how policymakers can harness the promise of telehealth and its rapid adoption during the pandemic. Watch it here.

• Recognizing a gap in measures available to assess the care received by oncology patients, PBGH worked with CMS to develop and test patient-reported outcome performance measures for patients with breast, lung and colon cancer, with the goal of these measures being included in federal oncology payment models.

• Encouraging providers to build capacity to collect data on patient-reported outcomes consistently through federal requirements will make it more feasible for private and public purchasers to include patient-reported outcome performance measures in contract and payment models, improving purchasers’ ability to assess the the quality of care their employees and members receive.

• Patient experience ratings were collected from more than 40,000 commercially insured patients for 176 provider organizations.

• The findings were publicly reported and used in a statewide pay-for-performance program.