Addressing Employer Concerns in Health Care Benefit Plan Design

October 2, 2020

In working directly with employers on their purchasing strategies amid the COVID-19 pandemic, notable concerns include independent primary care, consolidation, and quality of care.

In working directly with employers on their purchasing strategies amid the coronavirus disease 2019 (COVID-19) pandemic, notable concerns include independent primary care, consolidation, and quality of care, said Elizabeth Mitchell, president and CEO of the Pacific Business Group on Health.

Transcript

AJMC®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care® is pleased to welcome Elizabeth Mitchell, president and CEO of the Pacific Business Group on Health.

Can you just introduce yourself and tell us a little bit about your work?

Mitchell: Sure, I'm glad to be here. I am the president and CEO of the Pacific Business Group on Health, which is an organization of jumbo employers looking to find value in the health care system. We've actually been at it for about 30 years and have a really long history of innovating in the market.

AJMC®: Transparency of health care costs has long been an issue in the United States. Factoring in the COVID-19 pandemic, can you speak on how the Pacific Business Group on Health has worked to advise employers during this time?

Mitchell: We work directly with employers on their purchasing strategies, and all of them have been rightly concerned about frontline providers in this crisis and are looking for more flexible partnerships to support providers. They have been particularly concerned about primary care–independent primary care, they know that is the foundation of a high value health care system, and they know that they are at real risk.

So, they have expanded payment for telehealth, they have looked at changing their payment models, how they prospectively support primary care, community-based care, and really looking to ensure that providers have what they need to continue to thrive. At the same time, they're concerned about some of the trends they're seeing in the market like consolidation.

They saw billions and billions of dollars go into hospitals, which obviously they want them to have for patient care, but they want to make sure it goes to the right place, and they're very concerned about additional inequities developing for small and rural hospitals or independent providers who really need support. They just want to make sure that those resources are going to the right places.

AJMC®: Can you explain what factors are considered by employers when it comes to designing health care benefit plans? And which benefits employers are seeking to better incorporate?

Mitchell: I will say on behalf of our members, first and foremost, they are looking for quality and patient experience. So, their employee experience has to be good. They will prioritize quality over price all the time, but sadly, they can't get the information they need. Either it's not available because most health plan measures aren't real reflections of quality or they won't make results transparent.

In our work, we are measure developers. We have a measure development team in house, we have led testing of patient-reported outcome measures, and we are working on behalf of our employer members to actually get those into provider contracts because they want to identify and frankly directly partner with providers who can demonstrate better outcomes and better experience.