Patient-Reported Outcome Measures

Most employers have little or no access to summary information about their employees’ care experiences and outcomes. Yet tracking the effectiveness of health treatments and interventions is pivotal to improving care quality, enhancing the patient experience, supporting value-based care and reducing costs.

PBGH is leading a national initiative to achieve universal adoption of patient-reported outcome measures. Patient-reported outcomes offer an ideal means for gaining insight into the care process. They support more accurate and detailed assessments of treatment efficacy and also help reduce inappropriate and costly care. In addition, patient-reported outcome measures serve as an accurate predictor of an employee’s quality of life, productivity and ability to return to work.

PBGH has developed a comprehensive, multiyear plan for achieving universal adoption of patient-reported outcome measures. Our strategy involves:

• Demonstrating the feasibility of collecting patient-reported outcomes at scale in communities nationwide
• Creating momentum behind patient-reported outcome implementations by recruiting the support of influential stakeholders, including government agencies and major payer, provider and consumer groups
• Encouraging the adoption of consistent payment programs and the data infrastructure necessary to support universal use of patient reporting in routine care

As part of this effort, PBGH is engaging in federal policy discussions to support the integration of self-reporting in Medicare payment reform programs and other care redesign initiatives.

Purchaser Value Network

Health care’s legacy fee-for-service payment model encourages the delivery of volume while doing little to incentivize value or quality. Value-based payment models are changing this flawed dynamic to reward health care providers for quality and value and discourage unnecessary care. The Purchaser Value Network pushed to accelerate adoption of high-value health care delivery and payment models through policy advocacy, education and purchaser engagement.

The network:

• Injected purchaser perspectives and innovative best practices into federal and state policy decision-making
• Educated employers about value-based purchasing and advocacy opportunities
• Aligned the three critical purchaser sectors — private employers, states and the federal government — around evidence-based practices

Employers’ Prescription for Affordable Drugs

Led by PBGH, The Employers’ Prescription for Affordable Drugs (EmployersRx) is a coalition of The Purchaser Business Group on Health, National Alliance of Healthcare Purchaser Coalitions, The Erisa Industry Committee (ERIC), American Benefits Council, Silicon Valley Employers Forum and HR Policy Association. EmployersRx supports policies that would require PBMs to make pricing data available to payers and compel drug companies to report and justify price increases for some medications. The coalition also seeks to strengthen competition and remove barriers that stifle the development and use of generic drugs and biosimilars.

BACKGROUND

EmployersRx aims to mobilize large employers to drive down drug costs by educating and influencing public policies. Built on the tenets of transparency, competition and value, EmployersRx supports public policies that drive down the cost of drugs while preserving true innovation as part of a value-based health care system.

We believe that strong pharmacy benefit manager (PBM) reforms, which restore transparency and competition to the market, are critical to allowing employers to continue to offer affordable, quality health care to employees and their families. The complex rebate structure and total lack of transparency with respect to PBMs makes it difficult for employers to manage prescription drug costs. Federal legislation requiring robust transparency and accountability from PBMs to employers is critical for employer efforts to lower prescription drug costs.

OUR PRESCRIPTION

Transparency

Many drug manufacturers invest a great deal of money in research and development. But those costs and other factors that form the basis for establishing prices are extremely opaque. Increasing transparency at every level of the supply chain will provide consumers, purchasers and other stakeholders the information needed to ensure that effective treatments are obtained at a fair and reasonable cost.

Competition

The drug marketplace is characterized by counterproductive incentives, inefficiencies and anti-competitive practices that obstruct healthy price competition. Many newer drugs benefit from government-sanctioned monopolies through patent and market-exclusivity laws. Leveling the playing field by requiring fair business practices would encourage competition and drive down the cost of prescription drugs.

Value

Employers and employees pay more than ever for prescription drugs. But often the price is not aligned with the value of the product. The business models of some prescribing physicians and intermediaries, such as PBMs, often are misaligned with the interests of employers and patients, resulting in higher costs. We must stop rewarding payment structures and incentives that result in higher costs, and we must ensure that drugs are priced according to their value as a therapeutic agent.

Of particular concern for health care purchasers are the proliferation of specialty drugs with small markets. While these innovative therapies can be highly effective, their very high costs can be prohibitive for patients and purchasers. EmployersRx looks forward to working with policymakers to identify policies to balance the clinical benefit of specialty drugs with their overall cost to patients and purchasers.

COALITION MEMBERS

Transform Maternity Care

The cost of maternity care represents American employers’ second-highest annual health care expenditure. Yet U.S. maternal infant health outcomes remain among the worst in the developed world. Health care purchasers and patients deserve better.

That’s why PBGH works with employers, providers and health plans to develop a maternity care system that embraces high-value services, reduces outcomes variation and incentivizes safety across the prenatal, perinatal and postpartum care continuum.