The Purchaser Business Group on Health has released new data that highlights some of the key healthcare priorities of its jumbo employer members, with—perhaps unsurprisingly—the escalating affordability crisis as the biggest challenge.
Rounding out the top three priorities are data analytics and transparency, as well as an interest in advanced primary care. PBGH based the findings of a survey of more than two dozens of its members, which represent some of the largest employers in the United States.
Elizabeth Mitchell, president and CEO of PBGH, said in an interview that the escalating cost pressures have driven “a much more proactive approach from our members to address these concerns, which are simply not being addressed by the industry.”
“The urgency of that concern is absolutely growing,” Mitchell said. There is “also a heightened focus on transparency and understanding prices, and we are enabling that because they cannot just keep writing blank checks to the healthcare system when they have poor outcomes and just no demonstrable improvement in quality or value.”
She said that 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.
Alongside rising healthcare costs, employers have been under heightened pressure around their fiduciary duties as the requirements have become more stringent over the past several years. Mitchell said that these challenges represent “combined pressures.”
Increasing healthcare costs hit both the company’s bottom line and the employee’s paycheck. And at the same time, employers are being held increasingly accountable for understanding how much they’re spending and the value they’re getting back, which is why they’re so focused on transparency, she said.
Historically, employers of all sizes have struggled to gain access to the data necessary to get a full picture of their healthcare costs, savings opportunities and generated value. Enhanced fiduciary duties make that data transparency even more critical, Mitchell said.
“It just is really exposing to self-insured employers what they need to do differently, because cost increases are just accelerating,” she said. “They are not slowing down.”
Other focus areas highlighted by the study include pharmacy costs and PBM relationships; mental and behavioral health; weight management and cancer. Mental healthcare, metabolic conditions and cancer have all been cited consistently as cost drivers.
Mitchell said that high-cost claims overall have risen in dollar amount alongside the broader escalation in spending. And this trend doesn’t necessarily reflect a significant shift in the size or acuity of the patient populations, but is driven by ongoing price increases.
In February, Congress finally pushed federal reforms for PBMs over the finish line after years of discussion, and lawmakers have been amping up rhetoric around insurers as constituents reach out about the challenges they face with affordability and access.
With that added oversight, Mitchell said that both PBGH and its members have been actively engaged in conversations with regulators in multiple agencies about the risks posed by consolidation and the lack of transparency.
“We have seen a notable shift in finally holding the industry more accountable,” she said, “and we think that that is appropriate given the fiduciary obligations on self-insured employers.”
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