Em­ploy­ers must keep pres­sur­ing providers on costs

Modern Healthcare - - Q&A -

“In an ideal world, ev­ery­one should have ac­cess to qual­ity, safe, ev­i­dence-based health­care that is af­ford­able for work­ers, em­ploy­ers and the tax­pay­ers.”

Af­ter more than 13 years as the pres­i­dent and CEO of the Wash­ing­ton-based Na­tional Busi­ness Group on Health, He­len Dar­ling plans to re­tire at the end of April. While pres­i­dent of the NBGH, Dar­ling was named mul­ti­ple times as one of 100 Most In­flu­en­tial People in Health­care by Mod­ern Health­care. Pre­vi­ously, she di­rected health ben­e­fits pur­chas­ing at Xerox Corp. and was prac­tice leader at Wat­son Wy­att World­wide. She cur­rently serves on the Com­mit­tee on Per­for­mance Mea­sure­ment of the Na­tional Com­mit­tee for Qual­ity As­sur­ance and the In­sti­tute of Medicine’s Round­table on Ev­i­dence-Based Medicine, among other com­mit­tees and pan­els. She re­cently spoke with Matt Dun­ning, as­so­ciate edi­tor of Mod­ern Health­care’s sis­ter pub­li­ca­tion Busi­ness In­sur­ance, about the chal­lenges em­ploy­ers face in pro­vid­ing health ben­e­fits to their work­ers. The fol­low­ing is an edited ex­cerpt.

Dur­ing your time with the NBGH, what are some of the key changes you have ob­served in group health ben­e­fits?

He­len Dar­ling: First off, just look at how ex­pen­sive they are. It’s close to $15,000 per ac­tive em­ployee now. It’s had the ef­fect of mak­ing em­ploy­ers say they can’t con­tinue to sub­si­dize this sys­tem the way they have in the past. We’ve seen a move­ment to­ward more of a de­fined con­tri­bu­tion model in health­care. More em­ploy­ers, in­clud­ing the govern­ment, are say­ing they can only pro­vide so much, and plan mem­bers are go­ing to have to spend more of their own money. There’s much more shared cost than ever be­fore, and much more talk about the fact that em­ploy­ees have to be very ac­tively en­gaged. If they’re not, they’re go­ing to be spend­ing more of their own money, but they’re go­ing to do it in an un­in­formed way.

There’s been more change in to­tal in the last three to five years than I saw in my prior 25 years in health­care. The most rapid change has been to what I call the hy­bridiza­tion of Amer­i­can health­care. We now have in­te­grated de­liv­ery sys­tems like (ac­count­able care or­ga­ni­za­tions) and pa­tient­cen­tered med­i­cal homes. We have in­sur­ance com­pa­nies ac­quir­ing physi­cian of­fices and hos­pi­tals ac­quir­ing or cre­at­ing in­sur­ance com­pa­nies. Some­times it’s re­ally hard to tell them apart, be­cause they’re be­com­ing so in­ter­twined.

What do you see as the big­gest chal­lenges ahead for both the NBGH and the em­ploy­ers it serves?

Dar­ling:

I think it continues to be (about) con­trol­ling costs. You can’t get the growth rate of health­care costs down to zero, but you can get it closer to 3% in­stead of 6%, 7% or 8%. For em­ploy­ers, the chal­lenge is to find ways to keep do­ing that and to rec­og­nize that they can’t stop. It’s like try­ing to main­tain your own weight. You’ve got to get up ev­ery day and keep work­ing on con­trol­ling costs. Or­ga­ni­za­tions need to keep send­ing that mes­sage and keep pro­vid­ing more tools and re­sources to make it pos­si­ble, be­cause the world is chang­ing very rapidly.

In an ideal world, how would you like to see em­ployer-spon­sored health ben­e­fits change 10 years from now?

Dar­ling: In an ideal world, ev­ery­one should have ac­cess to qual­ity, safe, ev­i­dence­based health­care that is af­ford­able for work­ers, em­ploy­ers and the tax­pay­ers. It’s pos­si­ble that could oc­cur through a com­bi­na­tion of pub­lic-sec­tor pro­grams and pri­vate-sec­tor spon­sor­ship. I think it would have to look dif­fer­ent, more like the de­fined con­tri­bu­tion model and that sort of thing, but (it would have) em­ploy­ers— es­pe­cially large em­ploy­ers— re­main part of pro­vid­ing health­care, to help keep pres­sure on providers to keep health­care cost­ef­fec­tive and ef­fi­cient.

What are your plans af­ter you step away from the NBGH at the end of April?

Dar­ling: The NBGH board asked me to spend about 20% of my time through the end of 2014 as­sist­ing in the tran­si­tion. I’m also chair of the board of di­rec­tors of the Na­tional Qual­ity Fo­rum, which I will con­tinue to do at least un­til the end of the year. I’m on a cou­ple of other non­profit boards that I will con­tinue to serve on un­til those terms end, which will be within a year or two. Af­ter that, I hope that I will con­tinue to have op­por­tu­ni­ties to speak about this prob­lem of af­ford­abil­ity and what the cost of health­care has done to our other in­vest­ments in the na­tion, such as ed­u­ca­tion for chil­dren and univer­sity-level ed­u­ca­tion and train­ing.

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