Better Data Collection Essential to Understanding and Addressing Health Inequities
December 14th, 2022
The COVID-19 pandemic exposed and exacerbated the weaknesses of the U.S. health care system and highlighted long-standing inequities for minority communities. Highlighted during this period was the profound impact of economic stability, education, social and community life, one’s neighborhood and access to high-quality health care—social determinants of health—on the overall health and well-being of communities.
As a result, addressing health inequities has become a top priority for many employers, purchasers and health care providers. The ability to effectively collect a range of data points about patients and the care they receive is an essential component to creating meaningful change and ensuring populations achieve their full health potential.
Looking at health quality data by race, ethnicity, language and other patient characteristics, is crucial for understanding how long-standing systems of privilege and oppression impact the health of minority populations and communities. However, patient self-reported race, ethnicity and language (REaL) data across health insurance markets is widely variable and overall limited. While race and ethnicity data in California’s Medicaid program (called Medi-Cal) is broadly available likely because of legislation requiring health plans to collect this information starting in 2009, corresponding data for the majority of patients who receive health benefits through the commercial market – via employers or on the private market –is low or absent.
These limitations of known race and ethnicity data hinder the ability to see where disparities exist and for the health system to react with meaningful interventions. For health plans and large employers and purchasers, who provide health benefits for more than half the U.S., it is crucial to uncover variation in the access to care and the quality and experience of care being provided.
With better self-reported patient demographic information, employers, purchasers, payers and providers can tie this data to health care access, quality, patient experience and outcomes to illuminate exactly where disparities exist. These insights can enable tailored interventions and support for improvement.
How to Improve Data Collection
Legislation, Policy and Regulation
Legislation and regulations can incentivize or require health plans, providers and other health system organizations to increase the collection and quality of self-reported demographic data. Legislation and statute also have the potential to enforce standardization for data fields and definitions, which enables largescale purchasers of health care to align with their health plan and provider industry partners and enhance their ability to share, aggregate or disaggregate data to identify trends and implement plans for improvement.
It is crucial to ensure that national and state standards do not contradict each other.
Contracting and Business Relationships
Contracting requirements and incentives as part of large-scale public and private purchaser and payer programs can increase the collection, reporting and use of REaL data and thereby bolster efforts to mitigate disparities. Large purchasers could add incentive payouts if plans are able to stratify measures across self-reported REaL data. Health plans, provider organizations and other payers that contract within the health system can use incentive payouts for better data collection and stratification and other efforts to reduce disparities. Another approach is to build tiered networks that point patients to providers who have proven to be stronger at collecting, reporting and using REaL data.
It is important for purchasers and payers to avoid siloed initiatives that conflict with each other.
Organizational Leadership, Systems Structure and Culture
Organizations that pay for services at the point of care (e.g., health plans and independent physician associations, or IPAs) have the potential to increase REaL data collection, reporting and use by assessing and enhancing data collection opportunities, sharing data internally and creating a culture that values the collection of this information. This starts with organizational leadership. It is important to normalize data collection into regular workflows to improve the quality and ensure the most accurate information possible.
Purchasers, health plans and provider organizations can increase patient self-reporting by increasing awareness of how the data will be used and educating enrollment counselors and other staff with direct patient interaction on why it is important to collect this data.
The National Committee for Quality Assurance (NCQA) has required plans to report their percentage of self-reported REaL data for certain key measures, with a goal of 80% self-reported data. Additional accrediting organizations, purchasers and others could adopt similar certification requirements to support reporting and stratification for the same measures and self-reported data goals as NCQA. This would increase the consequences for not aligning and support the overall goal of greater availability of self-reported REaL data.
Read more in our latest issue brief.
What the End of the COVID-19 Public Health Emergency Will Mean for Employers
April 11th, 2022
The current COVID-19 public health emergency declaration has now been in place for more than two years – since January 2020. While a new wave could cause its extension, it will most likely end this summer.
Several policies that grant health care providers and payers extended authorities and flexibilities have been tied to the public health emergency, meaning these policies will go away when the public health emergency ends. But the health system has grown used to these extended authorities, and large employers need to be prepared for the potential impact of these policy shifts.
Several policies that will have a direct impact on large employers and other purchasers when the public health emergency ends are described below.
Discretion on HIPAA enforcement: To increase access to telehealth and ease the burden on providers, telehealth can be delivered on non-HIPAA compliant platforms. This discretion on HIPAA enforcement will end with the public health emergency. Most employers have moved to HIPAA-compliant platforms as the pandemic has stretched on, but those who have not will need to ensure all telehealth vendors are HIPAA-compliant when the public health emergency ends.
Waiver of Medicare site-of-service and benefits rules: The waiver of Medicare site-of-service and benefits rules is also tied to the public health emergency. While this does not have a direct impact on employers, some follow Medicare rules on site-of-service and benefits. It is important for employers who do to be aware that the waiver will end with the public health emergency.
State licensure flexibilities: One of the challenges with telehealth is that physicians will have to be licensed in the same state as the patient receiving care. Some states have created significant new licensure flexibilities to improve access to telehealth providers, though not all states have tied those flexibilities to the public health emergency. To the extent employers are using telehealth providers who are in a different state from employees, they should investigate if their state licensure flexibilities will end with the public health emergency and adjust policies accordingly.
Pre-deductible coverage: The CARES Act of 2020 allowed for coverage of telehealth services pre-deductible in high-deductible health plans. Many employers have chosen to take advantage of this option because it provides better access to care for their employees. This provision, which does not fall under the public health emergency, expired in December 2021 but was just renewed effective April 1 and will end on December 31, 2022. While some policymakers have signaled their intent to make the provision permanent, the on-again, off-again nature of the expiration and renewal has created a sense of “whiplash” for employees and employers. Employers must decide whether they will re-enact this policy with its currently limited duration.
Enhanced federal match and continuous coverage: To reduce the rates of uninsured people during the pandemic, two Medicaid changes were put into effect – an enhanced federal match rate and a continuous coverage requirement. Both will go away when the public health emergency ends, and it is expected that more than 10 million people will lose Medicaid coverage. As people lose coverage, employers should be prepared for a possible increase in the number of people seeking employer-sponsored insurance.
Enhanced subsidies: Although not tied directly to the public health emergency, in response to COVID-19, enhanced subsidies were implemented in the individual market to help uninsured people get and stay covered during the COVID-19 pandemic. These subsidies expire on December 31, 2022. If the public health emergency and Medicaid provisions end in July, enhanced subsidies may enable people losing Medicaid coverage to purchase inexpensive coverage on Affordable Care Act health insurance exchanges. When the enhanced subsidies in the individual market expire, it is expected that there will be an increase in people joining employer-sponsored insurance coverage, in particular partners of employees already enrolled.
Employers Continue to Lead through the COVID-19 Pandemic
September 2nd, 2021
Throughout the COVID-19 pandemic, employers have stepped up to lead, taking the actions necessary to protect their employees and their businesses. And the recent trend of vaccine mandates and incentives is just the latest example of that.
A plurality of PBGH’s nearly 40 members of large private employers and public health care purchasers have already mandated COVID-19 vaccinations for their employees. One of the first was Walmart, with The Walt Disney Company and others following soon behind.
With full FDA approval of one COVID-19 vaccine, more employers will likely adopt mandates, incentives and penalties to encourage their employees to become vaccinated, particularly since other mitigation measures — ongoing testing, wearing masks, limited employees onsite – would likely be needed for years to come. The administrative burden of these approaches is expensive and disruptive.
Still, Delta Airlines recently announced that unvaccinated employees will face a health insurance surcharge of $200 per month, bringing fresh questions about additional steps employers are likely to take to encourage employees to get vaccinated.
“It’s very much like smoking surcharges, and it is not unreasonable,” Elizabeth Mitchell, PBGH CEO told Yahoo Finance. “People can choose to smoke. They can choose to be unvaccinated. But that comes with additional costs for health care, and companies are paying those costs. Families are paying those costs because they hit everybody’s premiums. So, it is not unreasonable to expect those who are incurring greater costs to actually contribute more.”
Keeping the Workforce Safe
Having employees vaccinated is in the best interest of the workforce. Employers offer health benefits to keep their workforce healthy and to attract and retain talent, and people want to know that they are working in a company where they will be safe.
We also cannot overlook the cost of what are avoidable illnesses and the massive economic crisis this presents to employers and American workers alike. The average hospitalization cost for COVID-19 for a privately insured patient is over $30,000. In June and July alone, COVID-19 hospitalizations among unvaccinated adults cost the U.S. health system roughly $2.3 billion. Large employers who are self-insured are paying those bills – and ultimately, so are American workers — who will see those costs reflected in their health insurance premiums. Those added costs also come out of wages and job growth, which ultimately hurts employees and their families.
The expectation that employees will be vaccinated before showing up for work, is shared by businesses and the American public alike. A recent USA Today and Ipsos poll reported 62% of participants support employers requiring workers to be vaccinated.
Practical Steps to Encourage Employees to Get Vaccinated
Beyond mandates and surcharges, there are practical policies employers can put in place to encourage employee vaccination rates. In a new report based on the insights from qualitative research, The Commonwealth Fund offers recommendations for employers contemplating COVID-19 vaccination requirements for their employees:
- Provide honest, transparent and consistent messages.
- Connect science to the workplace policy.
- Demonstrate understanding that employees may feel unwell after receiving vaccinations and ensure policies support paid sick leave.
- Make vaccination easy with vaccination pop-up clinics at the worksite or by providing employees with a list of local pharmacies offering vaccinations.
- Consider and prepare for exemptions.
Click here for more information about these recommendations and how to apply them.
The human toll of COVID-19 on families has been enormous and employers understand they are in a position to lead and to make a meaningful difference for the health of their employees, communities and country.
We’ve seen PBGH members along with other businesses engage in a public-private partnership in which companies have joined state and federal governments in efforts to get more Americans vaccinated and to keep their communities safe. That’s what is required to put this pandemic behind us and get our economy and country back on track.
Opportunities in COVID-19 Vaccine Access and Equity
May 4th, 2021
While COVID-19 vaccine eligibility has expanded and supply has increased, data show that access to vaccines are not equitable throughout California’s communities.
Health care leaders are looking to work together differently as their vaccination efforts shift from trying to meet demand through mass vaccination sites to targeted interventions that address the needs and concerns of high-risk communities and vaccine-hesitant individuals.
In late April, PBGH’s California Quality Collaborative (CQC) hosted a closed roundtable discussion for health plans, provider groups and California state agency representatives to discuss challenges and success stories in their efforts to distribute COVID-19 vaccines and support equitable vaccine distribution for under-resourced populations. Five key actions stakeholders need to take emerged from the conversation:
1. Invest internally in policies supporting equity. During the past year, many organizations worked to improve internal processes that would better enable them to serve the diverse needs of their members and staff. L.A. Care Health Plan, the nation’s largest public health plan with nearly 2.2 million members, for example, developed a set of more robust internal policies to address diversity and inclusion, as well as programs designed to minimize barriers in working with minority or women-owned businesses, an approach described in the Clinical Improvement Network Connections spring 2021 publication.
2. Facilitate real-time data sharing. All groups agreed that, while there had been investments in data-sharing that facilitated collaboration to distribute and ensure access to vaccines, there were still gaps between health care delivery systems, public health and community-based organizations in terms of the accuracy of, and timeliness with which, essential clinical data was shared. As we begin to recover from the pandemic work should be done to ensure real-time data-sharing, especially between the California Immunization Registry and health information exchanges and organizations not traditionally part of health care information exchanges.
3. Provide clear, consistent and trusted communication. It was extremely important for all entities to streamline, test and regularly deliver communications campaigns to stakeholders, including community members, provider groups and member patients.
4. Leverage trusted relationships from primary care providers. Primary care providers were unable to play a significant role in the early days of vaccine distribution, often because mass vaccination sites were prioritized so individual practices received limited vaccine supply or were unprepared to accommodate the stringent storage requirements. With vaccine distribution having stabilized, there is an opportunity to tap into the primary care provider community, which is positioned to leverage long-standing patient relationships and play an important role in vaccination efforts. Increasing primary care’s role in COVID-19 vaccine administration may prove extremely effective in reaching vaccine-hesitant or skeptical patients.
5. Sustain new and strengthened partnerships. Overall, there was a recognition that the public health emergency and response has illuminated how effective cross-sector collaboration between health plans, public health departments, provider groups and community-based organizations can be at solving urgent problems when working together. Now, there is a question about how partnering groups can continue to collaborate while finding ways to become more efficient.
COVID-19 Vaccine Resources
4 Ways Employers Can Boost Vaccine Acceptance and Uptake
March 23rd, 2021
Employers have a critical role to play in helping end the COVID-19 pandemic by encouraging vaccine acceptance and uptake among their employees, including those most vulnerable to COVID-19, experts explained in a recent Purchaser Business Group on Health webinar.
“Your leadership really matters,” said Deb Friesen, MD, a physician advisor with Kaiser Permanente Clinical Solutions. “One of the things we’ve found is that your employees consider you the most trusted source of information related to the coronavirus, more credible than even government health organizations or the media. So, your role here is crucial.”
Friesen was joined in the March 17 webinar by Stephen Massey, managing director of the Health Action Alliance, a group formed to support employers in strengthening vaccine acceptance, advancing health equity and rebuilding public health.
“Even before all adults are eligible for vaccines, it’s important that companies begin preparing their workforce by sharing trusted information and making plans to reduce barriers to vaccination,” Massey said.
4 Steps Employers Can Take to Increase Employee Vaccinations
Friesen and Massey highlighted four steps employers can take to accelerate vaccine acceptance and uptake:
1) Spread a message of confidence and encouragement around vaccine safety and efficacy. It’s not so much that people are hesitant about vaccination; they simply need access to more trusted information about vaccines. Messages that encourage vaccination should focus on the importance of creating a safe environment for family, friends and co-workers, and emphasize that vaccines can help us all get back to doing things we love with the people we love.
Friesen also provided nuance about the vaccines that is valuable for people to understand and important for employers to include in their messaging: that when a vaccine is reported to have an efficacy rate of 95%, as with the Pfizer and Moderna vaccines, it means their chances of getting infected are decreased by 95% — not that those inoculated have a 5% chance of getting the disease. The studies on available COVID vaccines are demonstrating that each is incredibly effective, particularly when weighed against the annual flu shot, which in its best years is 40% to 60% effective at preventing disease. Significantly, each of the COVID vaccines currently available in the U.S. are 100% effective at preventing severe disease and the need for hospitalization.
2) Collaborate with community public health and health care partners to proactively engage workforce populations that may have unique concerns or questions, or who may need extra support accessing vaccines. Disproportionately lower numbers of Black and Hispanic Americans are receiving vaccines, despite their higher risk of infection, hospitalization and death from COVID-19. It is essential that employers develop targeted communications and policies to build trust and boost vaccine access among these populations. Engaging trusted messengers, including employee resource groups and other affinity networks, should be central to your strategy.
3) Make it easier to get vaccinated. Provide accommodations for vaccine appointments whenever possible for both full-time and part-time employees, contract workers and other personnel. Offer paid time-off and transportation to and from vaccination sites and childcare for employees who might otherwise be unable to schedule vaccine appointments. And as vaccine supply increases, consider engaging your local public health department and offering to host an on-site vaccine clinic at your place of business.
4) Take advantage of available resources. The Health Action Alliance has developed a wide range of free tools for improving vaccine acceptance and strengthening equity, including a sample communications plan, messaging for at-risk groups, peer-to-peer training and dialog and guidance for educating and engaging employees. Visit the organization’s website to learn more.
“At the end of the day, the most important thing any company can do right now is to share trusted information about the safety and efficacy of vaccines and make it as easy as possible for employees and workers to get vaccinated when it’s their turn,” Massey said. “By taking action to strengthen and accelerate the vaccine rollout, businesses can help turn the tide against COVID-19 and create a stronger, healthier future for everyone in America.”
Patient Experience and Telehealth During COVID-19: Investigating Key Success Factors and Obstacles
February 26th, 2021
The global COVID-19 pandemic has led to a rapid increase in virtual care delivery that will likely be long-lasting. During the height of the pandemic, fear of infection and stay-at-home orders meant that many practices stopped seeing most patients in person for routine care. Relaxing of government regulations allowed for widespread national adoption of telehealth.
Telehealth holds great promise for improving primary care through increasing access, improving patient experience and enabling team-based care models. Importantly, while telehealth expands access to all patients, it may improve health equity for lower socio-economic patients who may lack transportation or sick leave.
To gather the patient perspective on telehealth, The Purchaser Business Group on Health developed and fielded a telehealth patient experience survey as part of the Patient Assessment Survey (PAS) program. Approximately 12,000 surveys were distributed by email to patients with commercial and Medicare coverage who had a virtual visit (phone or video) with a primary care provider in California; 1,500 email responses are reflected in the research findings.
- Equal satisfaction between virtual and in-person care: No significant differences were found in ratings of patient visits between telehealth and the regular PAS survey responses (which measure in-person care).
- Telehealth was popular: A total of 87% of survey respondents recommend telehealth; of survey respondents, 73% want to continue using telehealth in the future.
- Video visits were favored over audio-only: Ratings of visits and communications were nearly identical in video and telephonic visits, but patients who reported that they would likely recommend telehealth and engage in repeat telehealth visits significantly favored video appointments.
- Provider communication was good: Most patients said the provider with whom they met via telehealth methods explained information in a way that was easy to understand (92%), listened carefully (92%), spent enough time with them (91%) and had relevant patient medical history on hand during the visit (88%).
- Most patients received medical tests: Half of survey respondents had tests ordered by their provider. Most followed up to have the tests conducted (84%), and most patients were able to access their test results (88%). Patients were most likely to get the tests ordered on their behalf while being seen for COVID-19 concerns, whereas patients being seen for chronic health care or other health issues were least likely to have tests ordered for them. Patients who did not receive ordered tests (16%) scored their health care provider lower on communication scores.
Despite these promising findings, PBGH research has been, to date, limited to commercial populations in the state of California. Further research on patient experience and clinical outcomes should be conducted nationwide with more diverse populations, including Medicaid beneficiaries, racial and ethnic minorities and those with limited English proficiency. PBGH will have preliminary results from a survey with a sample of patients with Medi-Cal coverage in Spring 2021 and seeks to expand this measurement nationwide.
The findings of the PBGH Telehealth Survey are instructive for provider organizations, solution providers and health plans. The survey findings suggest the following four steps can make a meaningful difference in ensuring that patients have a positive experience with telehealth:
- Continue to offer telehealth. Patients enjoy telehealth and want to continue using virtual care in the future.
- Offer video visits. Satisfaction with telephonic and video care was high, but users of video visits were more likely to recommend telehealth and want to continue using telehealth.
- Provide instructions for video visits. Patient satisfaction is highest when clear instructions are provided to the patient in advance of a video visit.
- Offer both virtual and in-person care options. Patients indicated the need for in-person options to evaluate certain physical concerns, such as broken bones or rashes. Patients feel they can determine if an in-person appointment versus virtual care is appropriate for their unique health issues.
Read the full report.
2021 Health Policy Priorities: Bipartisanship the Only Path to Success
January 19th, 2021
Beginning on Jan. 20, Democrats will hold a “trifecta” – control of the White House, Senate and House of Representatives – for the first time since Barack Obama’s first term in 2009.
Democrats have signaled that they intend to pass major health care legislation this year. While health care legislation has been the flashpoint of major partisan battles in recent years – most notably the passage of the Affordable Care Act in 2010 and its attempted repeal in 2017 – there is a real window for bipartisan support on legislation focused on reducing health care costs and improving quality. Over the past decade, the rate of inflation for medical services has averaged nearly 3% annually – roughly twice the rate of inflation for all other products and services. Unsurprisingly, recent public polling demonstrates that lowering the cost of care for individuals is the most popular health policy among voters. As the largest purchasers of health care, large employers know well the impact of the relentless increase in health care costs on their businesses and on their employees.
Post-COVID 2021 Policy Priorities for Large Employers
Like policymakers, employers are focused right now on stemming and ultimately defeating COVID-19. Once the pandemic is largely over, they will look to policymakers to pivot quickly to directly tackle high health care costs, inadequate quality and stubborn inequity in health care. But that does not mean it will be easy. Truly addressing the underlying problems in our health care system means directly challenging entrenched interests that perpetuate the broken status quo. That’s why taking on these issues can and should be bipartisan in nature.
Large private employers and public health care purchasers will be watching the actions of the Biden administration and new Congress with special focus on the following issues:
1. Broken Health Care Markets
Our health care system is rife with economic distortions, including inadequate competition, opaque pricing, uninformed consumers and a lack of actionable measures of quality. Large employers are interested in the changes policymakers will make to strengthen competition and transparency. Where markets have failed entirely or where there is no market, federal policymakers have a responsibility to directly manage prices, with an emphasis on strengthening competition via:
- Stronger health care anti-trust enforcement, including prohibitions on anti-competitive practices, to address the problems of industry consolidation, market power and high prices.
- Price transparency at the individual, health plan and provider levels, including unveiling negotiated prices between providers and health plans.
- Policies to increase healthy price competition among brand name drugs, generics and biosimilars
In highly consolidated health care markets, where dominant health systems have already driven up prices, it may be impossible to reinstate healthy competition. This may be particularly true in rural areas with very limited numbers of hospitals and physicians. In such cases, the federal government should directly set or constrain prices for all purchasers at fair and reasonable levels.
For pharmaceuticals with no effective competition (including many brand-name drugs under patent and/or market competition) the federal government should negotiate fair and reasonable prices available to all payers, as well as institute caps on inflation for prescription drugs currently on the market.
2. Rapid Acceleration of Payment Reforms from Fee-For-Service to Value-Based Models
Policymakers have long recognized that the fee-for-service payment system promotes higher volumes of care without accountability for the quality of care or patient experience. It is time for leaders to insist on the rapid adoption of value-based payment models for both public and private payers.
Population-based payment models, as described in the Health Care Payment Learning and Action Network’s framework, are the best way to provide flexibility to physicians and health systems while ensuring accountability for the total cost of care. The payment models must also include accountability for quality, patient experience and equity.
In the wake of the pandemic and the rapid rise of and need for remote care options, it is important to note that population-based payment models provide the right incentives for the expanded and appropriate use of telehealth services.
3. Adoption of Robust Performance Measurement with Focus on Health Equity
The ability of our health care system to deliver higher quality outcomes depends on the adoption of standardized and mandatory performance measures. Such measures are essential to the widespread adoption of value-based payments.
Performance measures should include clinical outcomes, patient-reported outcomes, appropriateness and equity. And they should be standardized and required for all physicians, hospitals and other clinicians to provide useful comparable information to patients, consumers and purchasers.
For too long, however, health care quality measures have failed to address underlying racial, ethnic and other disparities in health care. Performance measures should include the capture of racial and ethnic identification data. Further, quality improvement initiatives should focus on areas of greatest disparities, such as maternal and infant care and COVID.
Each of the policies described has enjoyed bipartisan support in the past. With just 50 Senators caucusing with Democrats and a five-seat majority in the House, the most viable path toward legislative success rests on bipartisanship.
For more on what large employers are prioritizing in 2021, read 7 Large Employer Health Care Priorities to Watch in 2021.
5 Health Care Provisions in the COVID Relief Bill Impacting Employers and Families
December 21st, 2020
Over the weekend, congressional negotiators reached a deal on a more than $900 billion COVID-19 relief package. This legislation will be tied to a year-end government funding bill. Among the many provisions in the bill are several of particular interest for employers and health care purchasers.
Below is a summary of the critical items of interest:
1. Surprise Medical Bills
After a two-year legislative fight, Congress is poised to finally pass legislation to ban surprise medical bills.
Consumer protections: If a covered individual receives out-of-network care without their consent (whether in an emergency or non-emergency situation), the individual will only be expected to pay their normal in-network cost sharing amount.
Negotiation between providers, insurers: The remaining balance of the bill will be negotiated between the health insurer and the provider. The two parties will have 30 days to negotiate a mutually agreeable payment rate. If they fail to reach agreement after 30 days, either party may request an independent dispute resolution process (IDR). Under IDR:
- Both parties will submit a “best final offer” to an independent arbitrator.
- Both parties may submit additional information justifying their offer, but the arbitrator is banned from considering providers’ billed charges and the payment rate from public payers, including Medicare. Further, the arbitrator must consider the median in-network payment rate for the service in the geographic area.
- Using “baseball style” arbitration, the arbitrator must choose one of the two offers.
- The arbitrator’s decision is final. The losing party is responsible for payment of the IDR cost.
Most care settings affected: The surprise medical bill protections apply to inpatient hospitals settings and outpatient care in emergency departments, outpatient clinics and surgical centers and clinician offices. They also apply to air ambulance transport. Unfortunately, they do not apply to ground ambulance transport services.
2022 implementation: Protections against surprise bills will take effect for health plan years beginning on or after January 1, 2022.
Impact: The consumer protections included in the legislation will put an end to the scourge of surprise medical bills and reduce the ability of certain providers from driving up costs by implicitly threatening to bill patients if they are not included in insurance networks. However, there is concern that the IDR process may be “gamed” by providers and will be less successful at holding down costs for purchasers than the proposed alternative of a benchmark payment rate for surprise bills. Nevertheless, the Congressional Budget Office and other independent analysts believe that the legislation’s requirement that the arbitrator consider the median in-network payment amount will be effective at holding down costs.
2. Health Care Price Transparency
No more gag clauses: The final bill will ban “gag clauses” from health plan/provider contracts. These clauses prohibit plans from disclosing to plan sponsors and individuals’ financial information including the allowed amount and provider-specific negotiated payment amounts for items and services covered by the health plan.
Drug spending disclosures: The bill also requires annual disclosure by health plans regarding spending on prescription drugs, including the most frequently dispensed drugs, the highest cost drugs, the drugs with the fastest rising spending and the effect of drug rebates, fees and other renumeration plan premiums.
Impact: The ban on gag clauses in provider/plan contracts will provide meaningful, provider-specific information to plan sponsors and individuals regarding prices. However, Congress chose not to include accompanying legislation that would give plan sponsors the tools they need to use this information to stop dominant health care systems from engaging in anti-competitive behavior. This will, unfortunately, allow health systems to continue to drive up costs for purchasers and consumers without improving quality.
In addition, Congress chose not to include meaningful reform to the way in which health plans and pharmacy benefit managers (PBMs) purchase drugs. Previously considered legislation would have provided drug-specific price disclosures, discounts and rebates, and banned PBMs from engaging in “spread pricing,” in which the PBMs directly profit from rebates and discounts they negotiate rather than passing them onto plan sponsors. Instead, the final language in the bill provides only high-level aggregated information without a ban on spread pricing. It is unlikely the legislation will result in any change in behavior by PBMs and health plans.
3. Direct Economic Relief
Stimulus payments: Up to $600 per person in direct stimulus payments to individuals, phasing out for families with income exceeding $75,000.
Increased financial support: Enhanced unemployment insurance benefits of $300 per week for up to 11 weeks.
Help for small business: $240 billion for Paycheck Protection Program loans for small businesses, including non-profit organizations. Qualifying PPP recipients will need to demonstrate significant revenue losses in 2020.
Impact: The enhanced unemployment insurance and extension of the paycheck protection program will help struggling families and keep the economy afloat during the pandemic. However, Congress did NOT include COBRA subsidies for employees who have been laid off or furloughed – many of whom have joined the ranks of the uninsured since the pandemic began. These subsidies would have provided important financial support and medical continuity for families affected by job loss.
4. COVID Response
The bill provides additional fund for vaccines and COVID testing practices intended to help get the pandemic’s spread under control.
Vaccines: $20 billion for purchase of vaccine doses by the federal government; $8 billion for vaccine distribution
Testing: $20 billion for states to conduct testing and contact tracing
Provider relief: $20 billion in additional economic relief for health care providers.
Impact: The COVID response funding made available under this bill is critical to helping the country exit the pandemic as swiftly and effectively as possible – the necessary step to reinvigorating the economy.
5. Flexible Spending Account Rollover
The legislation allows flexibility for taxpayers to rollover unused amounts in their health and dependent care flexible spending arrangements (FSAs) from 2020 to 2021 and from 2021 to 2022. It also permits employers to allow employees to make a 2021 mid-year change in contribution amounts.
Impact: This provision gives employers and employees flexibility in managing unexpected changes in health care costs during the pandemic.
Supporting Employee Mental Health During COVID: 4 Best Practices for Employers Considering Digital Solutions
September 8th, 2020
The COVID pandemic has created a rise of mental health concerns. One in four people already struggle with their mental health, and recent reports indicate 45% of people feel their mental health has been worsened by the pandemic. Mental health conditions are greatly impacting the workforce, with wide-reaching implications for well-being and workplace productivity.
Treatment can greatly reduce mental health symptoms, but many patients are not receiving proper care. Up to 60% do not receive treatment, and people often suffer for 10 years or more before receiving care. Access, cost and stigma pose significant barriers to the successful treatment of mental health disorders.
Digital is Trying to Fill the Gap
Digital tools have promised to alleviate many of the pain points with traditional mental health care.With 88% of Americans owning a smartphone, general interest in digital health care solutions has surged, as have the options for tapping into care via smartphone or other digital devises. There are as many as an estimated 22,000 digital mental health apps available to consumers offering care that spans from prevention to treatment.
Uses for Digital Mental Health Care
Large employers have an increasing interest in using digital tools to increase access for employees to behavioral and mental health benefits. While employer adoption of apps is currently low (not topping 11% of employers), more than 30% of employers plan to offer these services in the next few years. Recently conducted research with 10 large employers highlights their desire for on-demand access to a carefully selected network of providers, the ability to connect employees with a human, care based on evidence and that the user experience will be good.
4 Best Practices When Selecting Digital Tools
- Analyze your claims data to understand your top conditions and how much your company is spending on behavioral and mental health services
- Select tools that are specific to the top needs identified in your claims data analysis (i.e., if your top spend is on depression, select a tool that is designed to address depression)
- Gather referrals from other employers (an employer coalition is a great way to connect with peers
- Ask your benefits team to test the product themselves for ease of use, customer service and content quality; select tools that are highly rated by the team.
Make Offerings Easy to Find and Access
- Consider a single sign-on (SSO) for all benefits so employees can easily find the tool
- Reduce the number of sign-ons required for users to access the tool
- Encourage employees to create accounts before they need to access services – consider a benefits sign-up pledge to increase adoption
Develop an Employee Communications Strategy
- Create a communication campaign around employee mental health that includes information on available employee resources, information on mental health conditions and tips to improve emotional wellness
- Consider using an employee resource group to review campaign messaging before it is distributed to avoid stigmatizing terms
- Ask if employees are interested in forming volunteer employee resource groups around mental health
- Identify leadership champions and have open communication around mental health
- Increase communications during mental health awareness monthUse the vendor to help design an engagement plan to promote use of the tool – it’s their job!
Ongoing Evaluation of the plan is Essential
- Monitor employee engagement with your communications – track website clicks, tool downloads and webinar attendance to identify popular topics and increase offerings based on positive employee feedback
- Gather employee feedback through focus groups
- Set success metrics upfront, and have patience (within reason)
- Request frequent vendor data on outcomes, utilization, retention, user satisfaction
- Plug the gaps – regularly re-assess your employee needs, if your solutions are meeting those needs, and modify solutions accordingly.
The digitalization of health care is expected to increase exponentially in the next few years, catapulted by COVID-19. The pandemic has landed a one-two punch; in-person care has been limited and an increase of mental health issues is expected. Our current delivery system is not set up to care for people with mental health needs, especially those with lower incomes who cannot afford to pay cash for out-of-network care. Digital tools may play an important role in bridging that divide. Be sure to follow the 4 success factors above to increase your chances of success.
To read more about digital mental health tools used in the workplace, see Digital Solutions for Employee Mental Health.
Many Large Employers Placing a Hard Stop on Return-to-Work Plans
August 18th, 2020
The majority of large employers are pumping the brakes on return-to-work plans in the face of the dramatic rise in COVID-19 cases, even as they continue looking for new ways to reduce health and social inequities for employees and their families. Those were the findings of a recent member survey conducted by the Pacific Business Group on Health (PBGH).
Respondents included 15 large employers that collectively provide health benefits to roughly four million employees and their dependents.
Onsite plans in limbo
According to the survey, 57% of companies say soaring numbers of COVID-19 cases have led them to put their return-to-work plans on hold until circumstances change. About 43% say they’re continuing to plan for bringing employees back to the worksite, but with multiple, enhanced safety measures in place.
Given the widespread uncertainty surrounding the upcoming school year, the vast majority of companies surveyed (82%) say they’re creating flexible schedules for parents with young children. About 18% say they’re providing additional childcare options through specialty vendors.
The survey also found organizations are taking a variety of actions to improve social and health equity. Specifically:
- 67% are evaluating benefits and health & wellness programs to ensure equity in access and use
- 80% of organizations surveyed say their C-suite and/or Board directors are calling for organizational-wide initiatives to address issues such as hiring policies, promotional advancement and compensation equity
- 67% are working with local communities in the areas in which they do business
- 33% are hiring a diversity and inclusion leader
When it comes to specific steps aimed at strengthening health equity through benefit design and health system strategies, companies are likewise pursuing multiple approaches:
- 57% are ensuring health plans reimburse providers for telehealth services
- 36% are increasing primary care access and services
- 21% are expanding and/or ensuring employee access to culturally representative health care providers
- 21% are requiring that health plans provide utilization and outcomes data by race, ethnicity, language, and gender
- 14% are expanding benefits for non-medical services, such as transportation and nutrition
- 14% are expanding access for providers (for example, in underserved areas)
Addressing social determinants
The survey illuminated a greater awareness of the barriers created by social determinants of health: 85% of respondents said they intended to place greater emphasis on financial insecurity, food insecurity, transportation and/or all of the above.
In gauging the adverse impacts of health inequity on employees, large employers worry most about behavioral/mental health (73%), primary care (47%) and chronic disease management (53%).
As for partnering with public health entities to address health inequities, 21% said they were engaged with public health officials in communities in which they work, while 29% said they were not currently doing so but considering it.