Inaugural Employer-Provider Interface Council Conference Explores Value in Healthcare
In today’s fast-paced healthcare environment, managing health benefits requires dexterity, foresight, and collaboration. At the inaugural multistakeholder Employer-Provider Interface Council (EPIC) of the Hospital Quality Foundation interactive Leadership Conference that took place on June 11, 2019, the relationships among employer plan sponsors, employee healthcare consumers, and healthcare providers were explored. To understand how health benefits are managed to deliver value to stakeholders, several speakers discussed the importance of how to define and derive value in the rapidly changing healthcare industry. Each presentation was followed by reactions from a stakeholders panel from various segments of the healthcare industry, including consumer advocacy, employer, payer, government, and provider.
Starting the program was Mary Alice Lawless, Chairwoman and Founding Trustee, Foundation for Health Smart Consumers, Basking Ridge, NJ, which specializes in consumer and healthcare provider education. She spoke about the importance of defining value through the lens of consumers. According to Ms Lawless, consumers (or employees) derive value from having confidence in their assessment of options when selecting employer health plans, and their ability to improve outcomes through better self-care. However, less than 7% of healthcare plans are “shoppable” by employees, leading to a lack of perceived value, she added.
The stakeholders panel supplied anecdotes from their individual experiences, such as consumers not being very engaged in researching their plan options, despite readily available information. One explanation cited was that the amount of available information for some healthcare plans can be overwhelming to the average consumer. The panel also noted that quality care standards are not as easily obtainable as pricing information, which in itself is often difficult to acquire, so healthcare consumers usually make decisions based on prices instead of a combination of price and quality, thus not truly accounting for value when making healthcare-related decisions.
Neil Goldfarb, President and Chief Executive Officer, Greater Philadelphia Business Coalition on Health, PA, focused his remarks on employer needs and expectations as they relate to his work. Employers can make a significant difference if they properly leverage their market power, according to Mr Goldfarb, who has been working with employers to build a network of hospitals, pharmaceutical companies, consultants, and vendors to integrate healthcare programs in Philadelphia. One of the major achievements he has helped to produce has been improving health and well-being for employees through a diabetes program. As a result of having a healthier workforce, Mr Goldfarb has found that his network is supplying better-value healthcare and a successful waste-reduction program. Oncology is one area in which he has seen improvement in waste reduction.
According to Mr Goldfarb, one area of improvement is the need to educate employers on the benefits of data-driven initiatives to help make better healthcare decisions. He also believes that as the major purchasers of healthcare in the country, employers will eventually utilize their market power to influence value-based results. The panel discussed a couple of possible solutions based on their varied experiences, including the goals of using real-time data, and employers holding providers responsible for their contractual obligations to guarantee performance and yield value and better outcomes. An audience member raised concerns that unless the executive level, or a C-suite level executive was involved in negotiations and grant approvals from the start, a strain on building value-based relationships will persist.
Steven R. Peskin, MD, MBA, FACP, Senior Medical Director, Clinical Innovations, Horizon Blue Cross Blue Shield of New Jersey, discussed payer strategies to support employer–provider innovation. Dr Peskin highlighted the total medical expense as the most important factor and provided examples of multistakeholder collaborations in the state.
Kip Piper, MA, FACHE, President, Health Results Group, Washington, DC, spoke about the policy landscape in the United States from the perspective of the Centers for Medicare & Medicaid Services. As other speakers, he noted that educating stakeholders, including policymakers, is falling short. Central topics from the national perspective include expanding the role of Medicare Advantage plans, Medicaid block grants, and state legislation regarding drug pricing and access.
Jennifer Bright, MPA, Executive Director, Innovation and Value Initiative, Alexandria, VA, focused her attention on aligning stakeholders for activation regarding value. Ms Bright provided 3 main issues for discussing value, including (1) value assessment, (2) employer perspectives, and (3) methods of measurement. As part of value assessment, she noted that one issue that has not been approached is affordability. The Institute for Clinical and Economic Review (better known as ICER) doesn’t address affordability. No value can be derived without affordability, which is a component of value. From the employer perspective, trust is a big issue. Ms Bright highlighted that value can be defined in many ways, not simply by quality-adjusted life-years, which are used as a value measure in cost-effectiveness research and do not make sense in the commercial market.
The panelists also voiced their opinions that value should be measured in various ways, and that focusing on better health outcomes for patients should be the ultimate goal. For example, many high-priced oncologic medications are available, but some of those may only provide 3 additional months of life. The provider and the patient should have a very serious talk about the quality of those last 3 months of life to determine the value of the treatment for the patient. One panelist mentioned that hospitals spend a great deal of resources prolonging life, but perhaps the focus should be on productive life and not simply duration of life. The panelists agreed with Ms Bright that a more informed patient would help the provider discuss value-based options in the treatment plan.
EPIC’s inaugural fast-paced conference delivered on its goal of bringing together stakeholders from various healthcare segments to have engaging discussions about what value in healthcare means, consumerism effects, and legal or regulatory trends. For the foreseeable future, continued cooperation through effective collaborations will be imperative to align employer plan sponsors, employee healthcare consumers, and healthcare providers to deliver high-quality, affordable, valuable healthcare in the United States.
The event took place at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and was developed by EPIC and hosted by Rutgers University Health Outcomes, Policy, and Economics (HOPE) joint program in the Schools of Public Health and Pharmacy.