Unimaginable only a few months ago, health care organizations have experienced a radical reversal of fortune. Like many things upended by COVID-19, so is the long-held belief that the health care industry is recession proof – clearly, it is not. Health care organizations, like most businesses today, find themselves dependent on lifelines from the federal government, laying off health care workers and dramatically cutting spending.  

Considerable recent attention has focused on the federal grants to health systems across the nation to offset COVID-related losses. The conversations highlight the disparities among hospitals in terms of the populations they serve, their reserve balances, and ownership. The May 25th New York Times article, Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers, offers a detailed look into issues of equity across “have” and “have not” institutions.  

For me, the article underscores two things: (1) the political difficulties inherent in attempting to distribute money quickly, equitably, and thoughtfully, and (2) how very large and resource-rich some of our non-profit health systems have become. Multiple billions of dollars in reserves might only translate to months of operating income for many health systems.  

Missing from the conversation, and of critical importance, is how the federal government can use these lifelines to nudge our health care system toward long-term and widely-shared goals. These could include such things as payback requirements with forgiveness provisions for:

1. Investments that yield more primary care physicians;
   
   
2. Better chronic care management, as evidenced by low rates of hospital admissions or emergency department visits for treatable chronic conditions;
   
   
3. Adherence to evidence-based guidelines of care, demonstrated by decreases in services known to have little or no clinical value and that place patients at risk of physical, emotional, or financial harm; and
   
   
4. Limits on the levels of future price increases to private sector payers, already known to be significantly higher than government-sponsored health plans.

The pandemic is still with us. Its full economic impact lies ahead for most of us. The federal government has the opportunity to allocate taxpayers’ precious financial resources in ways that will best serve the American people and economy – ensuring a future in which all enjoy high-quality and affordable health care.

Warm regards,

Louise Y. Probst

BHC Executive Director

It has been two weeks since many St. Louis and national employers responded to the COVID-19 call to action: close workplaces for employees not directly involved in essential services. In almost lightning speed, and with the aid of technology and CDC guidance, HR teams prepared their workers to stay safe, connected, and focused while accommodating social distancing and this new way of life. I am impressed with employers’ agility and compassion in supporting their employees in the face of this significant health crisis. 

In the March 27th edition of the St. Louis Post Dispatch, physician leaders from local health systems (including BJC HealthCare, Mercy, SSM Health, and St. Luke’s Hospital) reached out to the public to share their insights, actions, and recommendations. With so much disjointed COVID-19 news, I felt reassured knowing that they are working together and coordinating resources and actions to meet the health care needs of the St. Louis community during this challenging time. The main takeaways from the collaborative statement were:

1. "No Visitor" policies are consistent across hospitals. Please be understanding of the importance of these precautions in keeping everyone as safe as possible.
   
   
2. Each health system has COVID-19 testing centers. Information about these centers can be found on their websites, along with virtual screening tools through BJC HealthCare and SSM Health. Unfortunately, supplies remain limited, so please call your hospital or health care provider ahead of time and understand that you may be asked to self-isolate at home, unless or until you have trouble breathing.
   
   
3. Please continue to be vigilant with hand washing and social distancing. Remember to stay active, eat healthy, sleep well, and connect virtually with family and friends in order to remain healthy and resilient.
   
   

To support well-being, the Midwest Health Initiative continues to update the LiveWellSTL website with online and at-home resources to move more, eat better, lose weight, and feel well. BHC members are also encouraged to visit our COVID-19 resource page and join fellow employers for weekly coffee chats in April to discuss evolving responses.

While there is much that we do not know about COVID-19, one thing is clear. We are in this together, and everyone has a critical role to play in slowing the spread of this virus. Social distancing will be necessary for longer than initially expected. We must stay the course. We owe this to those on the front line of health care serving our community.

Warm regards,

Louise Y. Probst,
BHC Executive Director

Last month, the American College of Physicians (ACP), the nation’s second-largest physician organization, endorsed Medicare for All. It finds the status quo of the U.S. health care system to be unacceptable, rejecting the notion that it is too politically difficult to achieve needed changes. This position contrasts that of most other health industry organizations, who have taken actions to strongly oppose Medicare for All proposals.

The ACP calls for a transition to a full-scale, single-payer health insurance program or a government-run health plan, competing alongside regulated, private insurance plans. While ACP acknowledges that there are advantages and disadvantages to each approach, it believes either solution could achieve universal and affordable coverage, while realizing ACP’s vision statements for the U.S. health care system. ACP encourages other organizations to also make a serious and transparent effort to define what would make a better health care system, evaluate options, and recommend action. 

While ACP’s support for a single-payer system may or may not align with that of an individual employer, several of its vision statements are spot-on, particularly, ACP’s call for greater investments in primary care and mental health services. Employers recognize that having a primary care relationship can translate to fewer hospitalizations and emergency department visits, earlier diagnosis, reduced overall spending, and happier patients. Several BHC members have already taken steps to support their employees in accessing and engaging with effective primary care and mental health services, while others are in the process of working toward this aim. If your organization is interested in joining in these efforts, please let Lauren Remspecher know.

In order to better support members’ interest in advanced primary care and mental health services, the BHC is pleased to announce that it has joined the Primary Care Collaborative (PCC). PCC is a national, multi-stakeholder membership organization that facilitates connections, resource development, and research focused on enhancing primary care in the U.S. Learn more by clicking here.

Adding to this conversation, the 2020 BHC Spring Forum on April 30 will highlight opportunities for employers to improve mental well-being in the workplace. In addition to examining mental health trends and treatment innovations in the field, speakers will provide actionable strategies for suicide prevention, stigma reduction, and the application of health benefits, policies, and programs to create a culture of support. Register to attend by clicking here. We look forward to seeing you there.

Warm regards,

Louise Y. Probst

BHC Executive Director

As we end 2019, I would like to acknowledge BHC members' commitment to improving health care and employee and community well-being. Your engagement in the coalition and with each other is greatly appreciated as we learn and work together toward better health and health care value. This energy was demonstrated by recording-breaking registration numbers for our 2019 Annual Meeting, totaling 436 members and community partners. The conversations sparked by our national speakers and local thought leaders were full of opportunity.
 
Andy Waldeck, Senior Partner at Innosight, painted U.S. health care as an industry ripe for disruptive innovation. He explained that “disruption" is a change that will transform an industry and bring meaningful improvements in affordability and accessibility to its customers. While he did not offer a specific timeline for when such innovation would occur, he created confidence that transformation is coming to U.S. health care and highlighted opportunities for purchasers and providers to accelerate desired change and thrive in the shifting landscape. 

Dr. Reena Duseja represented the Centers for Medicare and Medicaid Services, perhaps the greatest disruptor of U.S. health care to-date, and offered insight into CMS' use of measures and incentives to expedite the value and performance of their plans. As with other innovations, employers can learn from CMS' experience implementing alternative models for payment and delivery of care.

Dr. Wendy Levinson, Chair of Choosing Wisely Canada and Choosing Wisely International, reminded us that "more is not always better," especially when it comes to health care. Using educational toolkits and creative messaging, the Choosing Wisely campaign offers practical tips for engaging patients and physicians in reducing the culture of overuse in health care. Dr. Levinson reminded us that this is a problem across nations, not just in the United States, and offered several examples of success that has been achieved in provinces across Canada, other nations, and in many medical schools. Along with the St. Louis Metropolitan Medical Society and the Midwest Health Intiative, BHC has been working to identity situations of overuse in regional data and prioritize possible target areas for attention. A community collaboration to tackle overuse through diverse stakeholder engagement is preparing to launch in spring 2020. The work will align with the BHC Board's priority to develop a communication campaign to help the public become more informed consumers of health care. We would welcome your team's participation in this important initiative - please contact the BHC if you are interested in getting involved.

Linda Brady, Boeing’s health care strategy leader, provided an update on Boeing’s Accountable Care Organizations, advanced primary care efforts, and other strategies to achieve better value. She underscored the importance of leveraging relationships with health plan or provider partners to understand and influence care enhancements for employees. While a direct ACO contract is not feasible for all employers, there are many opportunities for employers with smaller or geographically-diverse populations to leverage puchasing power for better value. Moving into the coming year, the BHC’s new Value-based Purchasing Roundtable will explore advanced primary care solutions, including a visit to two local sites that have taken this approach.

Incoming BHC Board President and Chief Operating Officer for Francis Howell School District, Kevin Supple, closed the Annual Meeting with a heartfelt reminder of how peoples' lives are impacted by employer-provided health benefits and the difficult challenges that are faced by many patients. He inspired all of us to use our influence to make health care work better for employees, their families, and our community members. The BHC looks forward to answering this call in 2020 in collaboration with you.

Warm regards,

Louise Y. Probst

BHC Executive Director

For half a century, the U.S. health care system has undervalued and underpaid primary care providers relative to other specialists. The unintended consequences of this chronic underinvestment loom large: out-of-control cost, declining and inadequate access to primary care physicians, outcomes that lag behind other nations, high rates of overuse and medical mistakes, and growing evidence that financial incentives too often drive clinical decision-making.

According to the Patient-Centered Primary Care Collaborative (PCPCC), overall U.S. health care spending on primary care is assumed to be between 5% to 7%, half or less that which is spent in other developed nations. A recent study by the Milbank Memorial Fund found that primary care spending in Medicare was only 2% to 4% of its overall spending.  

Yet, considerable evidence has shown that a strong primary care foundation is essential for a high-performing health system. By example, regions with a higher ratio of primary care physicians have better health and lower rates of mortality from heart disease, cancer, stroke, and other causes, even after controlling for sociodemographic measures. Data from the Midwest Health Initiative confirms that commercially insured patients in St. Louis who regularly see a primary care physician are less likely to visit the emergency department.

Since it takes about a decade to train a primary care physician, and demand for their services is growing faster than the supply of new primary care providers, the time for action is now. Below are examples of truly meaningful strategies that warrant our attention and support.

(1) CMS recently announced that it is considering using different E&M (Evaluation and Management) codes for primary care and medical subspecialist physicians compared to those used for surgeons and other procedure-based physicians. The use of separate codes would enable CMS and private sector payers to begin to rebalance payments by offering higher increases to primary care providers, without automatically increasing reimbursements to other specialists. These codes would also better enable measurement of primary care spending relative to other specialties. On behalf of employers, the BHC recently offered its support for this proposal to CMS Adminstrator, Seema Verma.  

(2) State governments are taking real actions to require greater investment in primary care. By example, between 2009 and 2014, as a condition of having their rates approved, Rhode Island required commercial insurers to raise their primary care spending rate by one percentage point per year (in ways other than by increasing fee-for-service rates). The state’s primary care spending was 5.7% in 2008 and increased to 9.1% in 2012, while total health care expenditures fell 14%. Check out this quick summary of Rhode Island’s and five other state's efforts. 

(3) The PCPCC issued a call for a consensus process to define a common definition and standardized measurement of primary care spending. This would enable the value of primary care to be quantified over time, as well as comparisons across states, health plans, and accountable care organizations. It would also help guide future investments and the evaluation of new value-based payment models across payers and payer types. Read PCPCC’s call to action here. 

The BHC recognizes that many of its members have taken action to strengthen primary care through ACO arrangements, worksite clinics, or other health plan programs. If you are interested in sharing what you are doing or connecting with others on this path, please let me know. 

Warm regards,

Louise Probst
BHC Executive Director