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Defeat Diabetes STL

Posted By Lauren Remspecher, 10 hours ago
Updated: 4 hours ago

New Employer Partnership Aims to Prevent, Better Manage, and Reverse Type 2 Diabetes in St. Louis Community

 

ST. LOUIS, March 26, 2019 – Sixty employers are leading the charge to prevent, better manage, and reverse type 2 diabetes through a new community-wide initiative with the St. Louis Area Business Health Coalition (BHC). Co-chaired by local employers Anheuser-Busch Companies, LLC and Bi-State Development, the Defeat Diabetes STL campaign will explore opportunities to align health care, benefit, and well-being strategies to support employees and family members with prediabetes and diabetes. Over 100 million U.S. adults are impacted by these chronic conditions, with diabetes now ranked as the 7th leading cause of death nationally.

 

"As a local organization, Bi-State Development is dedicated to advancing the well-being of the St. Louis community through our people, businesses, and economic development. Our employees are critical to this mission, and we recognize that in order to have a positive impact, our team members must feel their best physically, emotionally, and socially. Defeating diabetes is an important step towards achieving this goal,” explained campaign co-chair, Dave Toben, Director of Benefits for Bi-State Development.

 

Through collaborative workgroup meetings, BHC employer members have identified four objectives to form the foundation for campaign activities:

 

(1) Deciphering the Data: Understand differences in the ways that vendors define metrics to assess prediabetes and diabetes using available data sources. Establish more consistent reporting and access to appropriate commercial benchmarks.

 

(2) Finding the Right Partners: Delineate key characteristics of effective programs for diabetes prevention, management, and reversal. Evaluate vendors and community programs and organize results into a meaningful comparison tool for employers to match preferences and needs in selecting potential partners.

 

(3) Learning From One Another: Share best practices and employer case studies on what is working (and not working) for diabetes prevention, management, and reversal, as well as tips for how employers can overcome common barriers and challenges.

 

(4) Getting to Action: Discuss and/or develop new communication and engagement strategies to increase awareness, participation, and personal accountability among employees and the community in addressing prediabetes and diabetes.

 

Campaign co-chair Brian Haschmann, Director, Health & Welfare, at Anheuser-Busch Companies, LLC echoed the importance this campaign for employers, “At Anheuser-Busch, we pride ourselves on our high ambitions and go-getter mentalities, but without good health we can’t be our best—at home, at work, or in the community. Our strength is in our people, and by defeating diabetes, we’re bringing people together for a better world.”

 

The two-year campaign will formally kick off during the BHC’s upcoming Spring Forum on April 10. The event will bring together top researchers, health care providers, employers, and well-being experts to discuss the latest science in diabetes prevention, management, and reversal. In addition to businesses, this community dialogue seeks to engage other stakeholders moving the needle of diabetes care management in the St. Louis community, including health system, insurance, pharmaceutical, and policy leaders. To learn more about this event and the campaign efforts, please visit www.stlbhc.org/page/DefeatDiabetesSTL.

 

The BHC is deeply appreciative of campaign sponsors, the Missouri Department of Health and Senior Services, Novo Nordisk Inc., and Naturally Slim®, for their generous support in making these activities possible. “It’s a privilege to partner with the St. Louis Area Business Health Coalition and its members to raise awareness of the importance of diabetes prevention across the region and beyond,” said Dr. Tim Church, MD, MPH, PhD, and Chief Medical Officer of Naturally Slim®. “Employers are on the front lines in America’s fight to improve population health and reduce health care spending from diabetes and obesity-related chronic disease, and Naturally Slim® is proud to stand shoulder to shoulder with them in this journey.”

 

About the St. Louis Area Business Health Coalition

The St. Louis Area Business Health Coalition (BHC) is a nonprofit organization representing 60 leading employers, which provide health benefits to thousands of lives locally and millions nationally. For 37 years, the BHC has worked to achieve its mission of supporting employer efforts to improve the well-being of their employees and enhance the quality and overall value of their investments in health benefits. To accomplish these aims, the BHC centers its work on providing pertinent research, resources, and educational opportunities to help employers understand best practices for the strategic design (and informed use) of benefits to facilitate high-quality, affordable health care. To learn more, please visit www.stlbhc.org or follow the BHC on Twitter and LinkedIn.

 

 

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Treating the Root Cause: A Silver Bullet for All

Posted By Louise Probst, Wednesday, March 6, 2019
Updated: Tuesday, March 5, 2019

This is not new. We have known definitively, for nearly three decades, that lifestyle decisions strongly correlate to the presence or absence of disease. Paying attention to what we eat, how much we move, how well we sleep, and our stress levels can lead to longer, healthier, and better quality lives. Research has identified that the choices we make have a powerful impact on turning on and off genes that cause and prevent diseases. With increasing evidence that chronic conditions like heart disease and diabetes can be both prevented and reversed, there is still hope for those of us who have not always made the best choices.

 

A thought-provoking discussion is bubbling in the medical community about the role and responsibility of physicians to bring lifestyle medicine into their practices. Is a physician falling short of their Hippocratic Oath when treating the symptoms of disease rather than the root cause? Could the personal belief of physicians that people will never change their lifestyle be putting some patients at risk of harm? Measures of physician quality, designed to determine if care is being provided in accordance with evidence-based standards, often look to testing and prescribing. Will the therapeutic use of lifestyle modifications to treat disease cause physicians to appear less effective?

 

In an aging society with high rates of chronic illness, medical spending twice that of most nations, and too much physician burnout, lifestyle medicine may be a silver bullet. The American College of Lifestyle Medicine (ACLM), a fairly new medical specialty society, happens to be located in Chesterfield, Missouri. They grew by 400% in 2018, confirming that physicians are turning to lifestyle science for therapeutic interventions. BHC staff met with a few ACLM leaders last week. Their enthusiasm for the role of physicians in supporting patients to live a healthier, better quality life was palpable. Lifestyle medicine may also be a cure for the profession. Grateful for the opportunity to truly help their patients find a cure, ACLM’s doctors seemed immune to the job dissatisfaction that so many providers claim to feel. Little else holds as much promise for chronically ill patients, physicians losing their joy, and a nation in physical and financial crisis.

 

ACLM leader, Dr. James Loomis, will share his personal and professional transformation during the BHC's April 10th Spring Forum. Please join us.

 

Warm regards,

 

Louise Probst

BHC Executive Director

 

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Ripple Effects, What Will They Bring? HHS' Proposed Rule to Ban Rebates

Posted By Louise Probst, Wednesday, February 6, 2019
Updated: Tuesday, February 5, 2019

After months of promising to do so, on January 31st the U.S. Department of Health and Human Services (HHS) proposed new regulations that upend the way drug companies negotiate with health plans and Pharmacy Benefit Managers (PBMs) for Part D and Medicaid programs. It is part of the Trump Administration’s commitment to reduce drug prices for patients and bring stronger competition and transparency to health care. HHS acknowledges that, while rebates can function like legitimate reductions in price, the use of rebates in the drug supply chain has brought increasingly harmful effects to market competition. Since the proposed action will occur through an update to the Part D safe harbor regulations, no congressional action is required.

 

Under the rule, rebates offered in exchange for formulary position would be banished. Two new safe harbors are created to enable price reductions at the point of sale and PBMs to be paid flat service fees by manufacturers. HHS believes that these actions will create strong incentives for drug manufacturers to reduce prices, as they are designed to deliver the “discounts” directly to patients at the pharmacy counter. This is what many drug companies have been calling for - a diminished role for middlemen and lower prices for patients. It could also stop bad behaviors by some pharmaceutical companies that use rebates to create barriers to competition for biosimilars, generics, and other new drugs.

 

Out for comment, the proposal suggests an effective date of 2020. Given the industry complexity and uncertain stakeholder response, it is hard to assess the potential impact. Like all sweeping changes, initially there will be winners and losers. Most agree Part D premiums will go up. HHS expects overall cost to patients and the government to go down and the long-term market effects to be positive.

 

While the rule only applies to Medicare and Medicaid plans, it would be naive to ignore the potential impact on commercially insured plans. Some expect the ripples of this action to shrink rebates in the private sector and lead to new purchasing models. Changes to the current business model seem almost certain. The focus on rebates and misaligned incentives has consumed public conversation, breeding widespread mistrust for too long. The BHC will stay informed, working to leverage stronger competition and refocus the conversation on fair pricing and achieving the best value.

Warm regards,

Louise Probst
BHC Executive Director

 

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CMS Requires "Chargemasters" to be Made Public: Charges Aren't Too Usable, At Least For Now

Posted By Louise Probst, Wednesday, January 9, 2019
Updated: Wednesday, January 9, 2019

For a competitive health care service market to exist, price transparency is essential. As of January 1, the Centers for Medicare and Medicaid Services now requires that every hospital operating within the U.S. (including specialized facilities) place a list, or “chargemaster,” online of its standard charges for all drugs, items, and services provided. Hospitals may also direct consumers to an alternate means for determining cost.

 

By shining a light on charges, CMS hopes to make health systems more financially accountable to the public. Ideally, this regulation will dampen cost inflation and heighten hospitals’ consumer-friendly communications, as patients navigate charges across facilities, determining their potential financial liability. While not required, hospitals may post quality ratings or other additional information, and some local hospitals have included the average length of stay and charge by diagnosis-related group. The format for reporting is left up to the hospital, as long as the information represents current standard charges and is updated annually in a machine-readable format.

 

A common criticism of the regulation, particularly from hospital executives, is “Nobody pays charges.” While most patients do not pay charges, it would be naive to think that higher charges are unrelated to future revenue increases, albeit not in a 1:1 ratio. Click here to see the trend in St. Louis hospital aggregate charges and revenues from the BHC’s most recent St. Louis Health Care Industry Overview Report (page 10). Patients finding themselves at an out-of-network facility are billed charges, and some insurers still contract on a percent of billed charges for certain services - commonly outpatient services. To get a better sense of how charges might be affecting your plan cost, you may want to ask your insurer for a breakdown of the percent of your total facility claim dollars paid under a per diem, a flat rate per case, or a percent of billed charges contract.

 

St. Louis hospitals are in compliance with this new law, but you may want to wait before making comparisons. Chargemasters frequently contain tens of thousands of items, with numerical codes representing technical names. Sometimes, multiple prices are listed across seemingly identical services with the charge code as the only distinguishing factor, and patients often do not know which code will cover their services. If you want to take a look, you can click on Mercy, SSM, BJC or St. Luke’s for links to their online chargemasters.

 

As time goes on, things will improve. Transparency vendors, researchers, and groups like the BHC will organize and interpret the data for easily-consumed, direct comparisons and encourage hospitals to standardize report formats. While we still have far to go, this is an important step toward tackling the complex issue of transparency in health care.

Warm regards,

Louise Probst
BHC Executive Director


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Leveraging Pharmacy Research for Better Value

Posted By Louise Probst, Wednesday, November 7, 2018
It is well known that U.S. health care spending is twice that of other countries while still obtaining worse results. Researchers at the Harvard T.H. Chan School of Public Health took a closer look and found that these differences are driven primarily by higher prices. Americans have roughly the same number of doctor visits and hospital stays as people in other affluent nations; we just pay considerably more for treatments, especially for drugs. In 2016, the U.S. spent an average of $1,443 per person on pharmaceutical drugs, compared to the range of $466 to $939 in other nations.

Comparative effectiveness research is a rigorous and objective process which evaluates the clinical and financial benefits and harms of medications, treatments, and therapies. It is central to determining coverage and reimbursement decisions in other nations, but its use in the United States has been rare. However, this is changing now that the Institute for Clinical and Economic Review (ICER) , the "watchdog" of U.S. drug prices, has taken aim.
 
At the next BHC Member Meeting on November 28th, Dr. Steve Pearson, Founder and President of ICER, will discuss the organization's current and future work, while also sharing insights on ways that employers can leverage this research to drive more effective clinical outcomes and reduce overspending on drugs. I hope that you will join us for this meeting. To register, please click here.

 

Warm regards,

Louise Probst
BHC Executive Director

 

 

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Health Care USA: A Cancer on the American Dream

Posted By Louise Probst, Wednesday, October 3, 2018

This report brings it all together: how rising health care costs have pushed the American Dream beyond the reach of most Americans, and how we all participated.

 

It was authored by two Towers Watson Consultants, Sylvester J. Schieber (retired) and Steven Nyce, and supported by the Council for Affordable Coverage. Analysis of wage and health care premium data from the 1980s onward, is used to demonstrate that the out-of-control growth in the cost of employer-provided health benefits has had a significant and negative impact on American workers. It shrinks workers' wage growth, erodes contributions to their retirement savings, and fuels growing income inequality.

 

All workers have been impacted; however, lower income earners have suffered the most. Rising health care costs have completely wiped out pay increases for the bottom 60% of U.S. workers over a thirty-plus year period. In 2001, 42% of the dollars spent to provide employee benefits went to health care and 58% to retirement. In 2015, 63.5% went to health benefits and 36% to retirement.

 

"So why has the United States, a nation that has led the world in productivity, done such a miserable job in organizing and delivering health care?"

 

The authors not only ask but also answer this question. Using both stories and statistics, they reveal how the organization and delivery of health care services in the U.S. is designed to sustain high cost. The failure of the federal government over this period to protect the public from anti-competitive mergers and the subsequent out-of-control price inflation is called out as a major contributor.

 

The final call to action is focused on employers: "While we all contribute to the problem to some degree - providers, purchasers, and consumers alike - only employers have both the means and the incentive to improve a value proposition in a health market that is so completely skewed toward the sellers and away from the buyers."

 

It's a long and worthwhile read (click here to view full report). Your thoughts and insights are appreciated.

 

Warm regards,

Louise Probst
BHC Executive Director


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What Will It Take to Get Rid of Waste in Health Care?

Posted By Louise Probst, Wednesday, September 5, 2018
In 2012, a study published in the Annals of Family Medicine, predicted the cost of family health insurance premiums to consume half of household income, on average, by 2021 and exceed it by 2033, if spending trends continue. It is hard to imagine that this could be possible, and yet, prices for health care services have increased steeply since the study was published.
 
The Midwest Health Initiative's (MHI) 2018 Scorecard of Health Stats for St. Louis Commercial Populations finds that medical spending per commercially-insured person grew by 29% since 2014 alone. The rate of people spending more than $500,000 annually grew by 186%. These increases seem to be driven more by higher prices than higher utilization.
 
The good news is that most health care insiders believe that 30% to 40% of services are "waste," meaning that they provide little or no clinical value. As a result, there is ample opportunity to lower costs without compromising patient care. Repeated research shows that, when care is evidence-based and effectively managed, patients can achieve better outcomes with fewer hospitalizations, tests, and treatments.
 
Removing wasteful spending through the public, employer, and provider lens is the focus of BHC's 2018 Annual Meeting, with the theme of Minimizing Waste, Maximizing Affordability: Standing Together for High-Value Health Care.
 
Frederick Isasi, CEO of Families USA, will deliver his call to action to the public and all health care stakeholders: make care affordable. Dr. Mark Fendrick, founder of the Center for Value-based Insurance Design (V-BID), will share the latest thinking on crafting employee benefits for higher value health care. As the co-developer of the Milliman Waste Calculator, he will share top areas of wasteful spending in St. Louis. Findings will come from the MHI database of 1.6 million commercially-insured people. At the event, there will also be a panel of local health care providers who will share their vision for better care value and the ways community partners can support one another in realizing this goal. We hope to see you there! Please click here to register.

 

Warm regards,

Louise Probst
BHC Executive Director

 

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Air Ambulance Prices and Practices: Opportunity for Change, Act Now

Posted By Louise Probst, Wednesday, August 8, 2018
Operating without price competition or oversight, air ambulance companies too often have taken financial advantage of Missouri patients. At last, an opportunity exists to put pressure on the unfettered pricing power of air ambulance companies across the nation. Thanks to the dedicated work of organizations like the Detroit Regional Economic Partnership and The ERISA Industry Committee, a legislative window of opportunity has opened. Employer support is needed to help it cross the finish line.
 
To ensure safe and coordinated service, the federal government currently regulates all air travel. The Airline Deregulation Act of 1978 (ADA), designed to increase price competition across national commercial airlines, prohibited states from determining the cost of any air travel. With the ADA extending to air medical transport, states have been blocked from enacting reasonable rules in response to air ambulance pricing practices.
 
With little reason for air ambulances to participate as an in-network provider, patients are left liable for charges above the "reasonable" payments made by their health plans. These regularly amount to tens of thousands of dollars and are accompanied by threatening calls from collection agencies. More common than you might hope, these air ambulance bills are a hardship for many Missourians and several BHC members - if you are not one yet, consider yourself lucky.
 
The Senate Committee on Commerce, Science, and Transportation is considering an amendment to a FAA reauthorization bill that will enable states to regulate air ambulance pricing practices. As an employer, you can make an impact by sending Missouri Senator Roy Blunt (who sits on this committee) a message asking for his support or by having your government affairs representative reach out to the Senator's staff. This matter has been a challenge for BHC members for over a decade, but the combined engagement of Missouri's leading employers will help make change possible.
 
Click here to see a fact sheet about the issue and to view BHC's letter to Senator Blunt.
 
Warm regards,

Louise Probst
BHC Executive Director

 

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Get Costs Under Control, Or Else

Posted By Louise Probst, Wednesday, July 11, 2018
In late 2014, rising health care costs had put Montana's benefit plan reserves near negative territory. Recognizing that state employees' wages were already being held down as the result of high costs, Montana legislators told the Health Benefits Division Administrator Director, "Get these costs under control, or else."That pressure led Montana to a solution that today begs the question, "Why haven't we always done this?"
 
A comparison of hospital costs found wide variations for like services, with some hospitals charging commercially-insured populations as much as six times Medicare rates for outpatient services. Understanding that Medicare payments are sufficient for an efficient hospital to cover its cost of service and gain a small profit, the Montana State Employees Plan reversed the process. Instead of beginning with a hospital's list price and negotiating down, they offered a reference price for each service set at an average of 234% of Medicare.

One concern was that, while some hospitals would be forced to decrease their prices for State employees, other lower cost hospitals would have the option to increase theirs. Since traditional plan designs and PPO structures favor higher cost providers at the expense of their lower cost competitors, this could be seen as an opportunity to right a wrong. Other worries were that some hospitals would decline to participate or that price reductions would limit the availability of treatment options or trigger a reduction in health care jobs. However, in Montana, all hospitals eventually signed on to the agreement, and not one has filed for bankruptcy in the past two years.

Saving an estimated $15.6 million over expected spending just this year, Montana's success leaves other states, large employers, and business health coalitions hopeful that communities can work together to reduce health care spending without limiting needed care. As Yale economist, Zack Cooper, underscored, hospitals that claim that Medicare only covers 90% of their costs need to review their spending and investment decisions.
 
Warm regards,

Louise Probst
BHC Executive Director

 

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American Patients First Act: Bringing Drug Prices Back to Earth

Posted By Louise Probst, Thursday, June 7, 2018
On May 11th, President Trump and Secretary Azar announced the American Patients First plan. It is designed to respond to "astronomically high drug prices" and address the President's campaign promise to lower the cost of pharmaceuticals in the country. 
 
While the implementation timeline set forth by the Secretary spans weeks, months, and years, there is a clear desire from the President and the American public to get things moving. A recent poll by the Kaiser Family Foundation found that 80% of Americans believe that drug costs are unreasonably high, and just over half of the public (52%) says enacting legislation to lower the price of pharmaceuticals should be a "top priority" for the Federal government.
 
The plan underscores three main areas of focus: tougher negotiations, greater options (competition) for delivering medications currently administered as part of the medical benefit, and reduced patient payment amounts, perhaps through a requirement related to point of sale rebates. A long list of other possible actions has been identified for consideration. The list includes requiring pharmaceutical companies to disclose prices in product advertisements, which some think is beyond the legal abilities of the FDA, and requiring fiduciary status for Pharmacy Benefit Managers (PBMs).
 
Little disagreement is being voiced, as public outrage heightens daily over unaffordable prescription drug costs. Americans feel the pinch of exorbitantly-priced new medicines, as well as previously inexpensive generic drugs with prices now growing tenfold overnight, and they are being quite vocal about their dissatisfaction. There is much work to be done to thoroughly examine opportunities and design proposed actions across the myriad of interested parties. The BHC will be following and sharing developments of the plan and advocating for purchaser and consumer interests. Please contact Bridget Haeg Montroyor me with related questions, thoughts, and suggestions as we work together to ensure that, in the end, the long-term interests of American patients come first.
 
Warm regards,

Louise Probst
BHC Executive Director

 

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