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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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St. Louis MetroMarket: An Opportunity to Do Good for Your Employees and Your Community

Posted By Louise Probst, Thursday, May 3, 2018
The St. Louis MetroMarket, a farmers' market on wheels, is a feast for all of the senses . This eye-catching nonprofit has transformed a donated city bus into a mobile grocery store, fully stocked with fragrant and flavorful seasonal fruits, vegetables, spices and pre-made meals. At the core of the organization is a mission to bring healthy, fresh foods to neighborhoods without access to them, and make it easier for people without sufficient transportation, time or money to eat healthy.
 
Like many other attendees of BHC's Spring Forum last week, I had the opportunity to step into this farmers' market. It was clean, bright, fun and full of superior fresh produce at prices that were equally as attention-grabbing. In addition to a bag of healthy food, I came away with high expectations for MetroMarket's potential to help increase the consumption of fruits and vegetables in St. Louis. According to the CDC, eating five servings of fruits and vegetables each day is one of the most important practices for healthy living.
 
With the support of the American Heart Association, the BHC is partnering with St. Louis MetroMarket to help employees eat healthier in the workplace. New in 2018, the St. Louis MetroMarket is now scheduling visits to workplaces in the St. Louis area. You can set up a 2-hour visit to your organization's parking lot and provide a convenient and fun opportunity for employees to grocery shop or grab a quick, healthy lunch. Other services include free recipe cards with each purchase and an evaluation report to provide insights on employee engagement and purchasing behaviors.
 
Adopting use of this roving farmers' market is an opportunity to encourage healthy eating among your employees as well as provide additional support towards the organization's vision of a healthier St. Louis for every community. For more information, please contact Lucas Signorelli, Executive Director of the St. Louis MetroMarket, by email at lucas@stlmetromarket.com or phone at 314-475-0398.
 
 
Warm regards, 

Louise Probst 
BHC Executive Director

  

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CMS Hospital Star Rating: Four St. Louis Metro Hospitals Awarded Five Stars

Posted By Louise Probst, Wednesday, April 4, 2018

Congratulations are due to four St. Louis metro area hospitals whose quality results have earned them recognition as a Five-Star Hospital by the Centers for Medicare and Medicaid Services (CMS). Similar to the Overall Star Rating Program for nursing homes and health plans, CMS has also developed a Five-Star Quality Rating System to help consumers make quality comparisons on hospitals in an easily comprehensible way. Although CMS has reported star ratings privately to hospitals for some time, hospital scores have only been public since summer of 2016.

 

After taking public comment, CMS revised its rating system in 2017. As a result, the number of five-star rated hospitals increased from just 83 to 337. Yet, a five-star ranking remains exceptional. Out of the more than 4,000 hospitals rated nationally, less than 8% of hospitals have achieved this distinction. The rating program covers 57 quality measures across seven areas of performance: 1) mortality, 2) safety of care, 3) readmission, 4) patient experience, 5) effectiveness of care, 6) timeliness of care and 7) efficient use of medical imaging. Another 67 considered measures were excluded due to overlap and/or fewer than 100 hospitals reporting on them. Additional methodologic changes were also made.

Performance varies across hospitals by measure and category. Not all top-rated hospitals receive the highest scores in every area. Since mortality, safety, readmissions and patient experience are more heavily weighted than the other three measures of performance, top-rated hospitals generally operate well in those categories. The public release of the CMS star ratings for hospitals was not available when MHI was creating ChooseWellSTL.org. As a new program, MHI decided to consider adding hospital stars in a future site update. The user-friendly CMS site shows hospital comparisons in an easily understood five-point scale, while also enabling users to scrutinize hospital performance further on specific, individual criteria, according to their interests.


Warm regards,

 

Louise Probst

BHC Executive Director


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Type II Diabetes: No Longer a Life Sentence

Posted By Louise Probst, Wednesday, February 7, 2018
Diabetes has long been considered an incurable, progressive disease where high blood glucose levels impair circulation to the extremities and vital organs. Treatments use diet, exercise, and medication to enable those living with diabetes to remain active for as long as possible. Overtime, patients usually require multiple medications to normalize their blood sugar and the disease diminishes their energy, sleep quality, and general well-being.
 
Reversal of type II diabetes was almost never a treatment goal, particularly in those afflicted for several years. This has changed. New research has many doctors agreeing that a healthy lifestyle can virtually eliminate the risk of type II diabetes in pre-diabetics or entirely reverse an existing condition without medication.
 
One 15-year study published in 2015 compared the effectiveness of a healthy lifestyle with the use of diabetes drugs in 3,000 pre-diabetics. It found that those who followed the diet and exercised for at least 2 hours each week saw greater benefit than those on medication.
 
Virta Health, a company focused on reversing diabetes, has found success with an approach to food that embraces fats while limiting carbohydrates. This creates a "nutritious ketosis," enabling patients to feel satisfied with less food intake while improving the insulin sensitivity of their cells. A Virta Health study found that 87% of participants were able to reduce or eliminate insulin, 56% lowered their HbA1c below diabetic levels, and participants achieved an average of 12% weight loss. Using various approaches, several other companies that focus on supporting patients with diabetes to live healthier lives are reporting noteworthy outcomes. 
 
Energized by the opportunity to support employees in reducing or removing the complications associated with diabetes, BHC members and Board prioritized preventing, managing, and reversing type II diabetes as a shared focus for 2018 and beyond
 
Interested in helping guide this work? Lauren Schulte, BHC's Director of Well-being & Communications, would like to hear from you by email or phone (314-721-7800). Also, please attend the April 27th Spring Forum, Weighing In: New Considerations for Addressing the Obesity Epidemic.

Warm regards,


Louise Probst
BHC Executive Director

 

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The Tax Cuts and Jobs Act: Will It Put Health Care Reform Back in Play?

Posted By Louise Probst, Wednesday, January 10, 2018
On December 22, 2017, the Tax Cuts and Jobs Act was signed into law, becoming the first significant U.S. tax code reform since 1986. Like many industries, health care organizations are scrambling to understand what this means for their bottom lines while bracing for seemingly inevitable funding cuts.
 
The greatest impact on individual insurance coverage is the repeal of the individual mandate penalties from the Affordable Care Act (ACA). According to the Congressional Budget Office (CBO), repeal of the penalties could cause people who were previously buying coverage to step away from it and deter others from purchasing. As many as 13 million additional Americans may be uninsured.
 
Early 2018, the Department of Labor released a proposal to enable association health plans to offer insurance coverage to individuals and employers in a state, city, county, or that serve an entire industry nationwide. Despite former shortcomings, supporters are optimistic that these will provide more choices in coverage and drive down prices. When they failed previously, there was no "guaranteed issuance." Put in place by the ACA, this provision forbids the use of a person's medical history in underwriting and could minimize the adverse selection issues which doomed prior efforts.
 
A common belief is that the tax cuts will create a rising pressure to reduce federal spending, and opinions differ on whether this is a good or bad thing. With thirty percent of the federal budget (or $1.25 trillion) dedicated to Medicare and Medicaid funding, it is understandable that these programs might be early targets. Policy experts understand that changes to the programs are needed. Bipartisan committees have studied options to reduce their spending for decades, only to kick the can down the road. The concern is that current political and financial pressures will result in action without appropriate testing and implementation.  Solutions in discussion include an increase in the enrollment eligibility age, reduction in coverage levels, imposed maximum spending limits per beneficiary, or more required cost sharing with beneficiaries. 
 
While it is unclear whether the U.S. Senate has the appetite to take on Medicare, Medicaid, and health care reforms this year, it does seem certain that the health care reform debate will rise again.
 

Wishing you all the best in the New Year,  

Louise Probst
BHC Executive Director

 

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Hour of Power: Healthy Tips for Staying Jolly this Holiday Season

Posted By Louise Probst, Wednesday, December 6, 2017
For many, the holiday months bring good tidings and cheer, but portions of the population find that seasonal pressures are making them blue. One in five adults will suffer from major depression at some point, often during prime working years. Associated costs include $51 billion in productivity loss and $26 billion in direct treatment costs, according to Mental Health America, and depression increases the risk for other chronic diseases.

Over the years, multiple studies have indicated that exercise can mitigate and even prevent depression. Today, new research further emphasizes this point, showing that even small amounts of physical activity can largely influence psychological well-being.

One Norwegian survey tracked exercise habits among 34,000 adults and found that people who exercised for just one hour a week were 44% less likely to develop depression over a decadethan those who did not exercise at all. Results suggested that while more intense or lengthier exercise may boost physical health, a simple walk sufficed to achieve mental health benefits. "This was not a case of more is better," explained study author, Samuel Harvey. "The vast majority of the mental health benefits of exercise were realized when individuals moved from doing no regular activity to 1 or 2 hours per week."

Employers can collaborate on strategies to get employees out of their chairs and away from their screens. Those interested in finding ways to help their employees reap the mental health benefits of physical activity are encouraged to contact Lauren Schulte, Director of Well-being & Communications, to learn more about the BHC's free health improvement resources.

Warm regards,
Louise

 

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The Health Care Cost Conundrum: Looking Back to Move Forward

Posted By Louise Probst, Wednesday, November 1, 2017
The St. Louis Area Business Health Coalition (BHC) recently marked its 35th year of connecting and representing the region's leading employers on health care issues. While much has changed since the BHC's founding year of 1982, the driving force behind the organization remains the same: concern for annual increases in health care costs which outpace the growth in all other areas of the economy.
 
BHC founding employers recognized that, as purchasers of health benefits, they were inadvertently fueling excessive growth of health care utilization and cost. They knew that their benefit offerings created and unleashed "cost unconscious consumers" into the health care market. Familiar with responding to customer demands, they also understood the role consumers have in shaping products and disciplining markets. BHC founders held deep concern for the long term impact of a market where consumers utilized whatever was produced and at whatever price. They joined together to learn about health care and to leverage their collective power in ways that would help flatten the cost curve and push for medically necessary, high-quality care.
 
As 2018 draws near, it seems appropriate to glean inspiration from the vision and aspirations held by BHC founders. Sometimes, looking back is the most effective way to move forward. Borrowing from a 1970s comic strip, one of the BHC's foremost thought leaders put it best when he quoted, "We have met the enemy, and he is us."
 
Thank you, BHC members, for 35 years of purchaser leadership in health care. Please join us in celebrating this occasion by attending our November 3rd Annual Meeting, Getting to Affordability: Facing the Cost Conundrum.

Warm regards,
Louise Probst

BHC Executive Director

 

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