The Purchaser Business Group on Health has released new data highlighting some of the top healthcare priorities of its giant employer members, with, perhaps unsurprisingly, the growing affordability crisis as the biggest challenge.
Rounding out the top three priorities are data analysis and transparency, as well as interest in advanced primary care. PBGH based the findings on a survey of more than two dozen of its members, representing some of the largest employers in the United States.
Elizabeth Mitchell, president and CEO of PBGH, said in an interview that increasing cost pressures have driven “a much more proactive approach by our members to address these concerns, which simply are not being addressed by the industry.”
“The urgency of that concern is absolutely growing,” Mitchell said. “There is also a greater focus on transparency and understanding of prices, and we are allowing that because they can’t continue to issue blank checks to the health system when they have poor outcomes and there is simply no demonstrable improvement in quality or value.”
He said employers are increasingly open to seeking bids from new pharmacy benefit managers (PBMs) or third-party administrators in hopes of finding a better model that works.
In addition to rising healthcare costs, employers have come under increased pressure around their fiduciary duties as requirements have become more stringent in recent years. Mitchell said these challenges represent “combined pressures.”
Rising healthcare costs affect both company results and employee salaries. And at the same time, employers are increasingly responsible for understanding how much they spend and the value they receive, which is why they are so focused on transparency, he said.
Historically, employers of all sizes have struggled to gain access to the data needed to get a complete picture of their healthcare costs, savings opportunities, and value generated. Enhanced fiduciary duties make data transparency even more critical, Mitchell said.
“This really exposes self-insured employers to what they need to do differently, because cost increases are accelerating,” he said. “They’re not slowing down.”
Other areas of focus highlighted by the study include pharmacy costs and PBM relationships; mental and behavioral health; Weight control and cancer. Mental health, metabolic diseases, and cancer have been consistently cited as cost drivers.
Mitchell said overall high-cost claims have increased in dollar amount along with the broader escalation in spending. And this trend does not necessarily reflect a significant change in the size or severity of patient populations, but is instead driven by continued price increases.
In February, Congress finally pushed federal reforms for PBMs across the finish line after years of discussion, and lawmakers have been ramping up the rhetoric around insurers as constituents warm up to the challenges they face with affordability and access.
With that added oversight, Mitchell said both PBGH and its members have been actively engaged in conversations with multi-agency regulators about the risks posed by consolidation and a lack of transparency.
“We’ve seen a notable shift in finally holding the industry accountable,” he said, “and we think that’s appropriate given the fiduciary obligations of self-insured employers.”
