Business health group maintains focus in midst of health care reform

The National Business Coalition on Health aims to improve population health, the quality of health care delivery and efficiencies to lower cost.

Greg Kraupa

The leader of the National Business Coalition on Health, at its annual conference in Washington, pledged no change to the group’s three areas of core focus as health care reform takes effect.

The National Business Coalition on Health (NBCH) represents 80 employer-led coalitions, more than 7,000 large- and medium-sized employers and 25 million employees and their dependents. The NBCH members are committed to improving the value of health care provided through employer-sponsored health plans.

One year after the Patient Protection and Affordable Care Act (PPACA) was signed into law, the NBCH looked at how to incorporate the new reform act provisions into its long-term goals.

Andy Weber, president and chief executive officer of NBCH, indicated that its three areas of core focus would not change. They include improving population health, improving the quality of health care delivery and improving efficiencies to lower cost. Mr. Weber indicated that NBCH was a key resource for effective reforms, but he stressed that true reforms would happen with their members at a local level.

U.S. Secretary of HHS

U.S. Secretary of Health and Human Services, Kathleen Sebelius, a keynote speaker, reported that status quo in U.S. health care is no longer an option. For every dollar U.S. businesses spend on health care, foreign businesses spend 40 cents or less, she said. In addition, she added that we have one of the least healthy populations of any industrialized country. On average, 480,000 employees call in sick every day, and Medicare is spending $1.5 billion per day to treat disease, she said.

She indicated that specific new models of payment and delivery would be tested, including the patient-centered primary care medical home, state insurance exchanges, accountable care organizations (ACOs) and payment bundling.

Sec. Sebelius reported on the creation of the CMS Innovation Center, a private-public collaborative charged with shortening the process of bringing best practices from concept to implementation. She announced to the group, with an enthusiastic response, that an Innovation Center “dream team” had been created. Two members of this team are Carolyn Clancy, MD, the director of the Agency for Healthcare Research and Quality, and Peter Lee, former CEO of the Pacific Business Group on Health.

Panels debated PPACA

Not all aspects of the PPACA were greeted with equal enthusiasm. There was spirited debate by moderated panels made up of people with diverse opinions. Randy Johnson, senior vice president of employee benefits for the U.S. Chamber of Commerce, supported a full repeal of the health reform bill but admitted their group would have to settle for incremental modifications.

Doug Henley, MD, executive vice president of the American Academy of Family Practice, and Richard Trumka, president of the AFL-CIO, on the other hand, fully supported the reform bill contents.

Panel members expressed concerns about the coverage and funding provisions in the PPACA. With the dramatic change in legislative make-up after the mid-term elections, there was agreement that modifications to the current reform bill will take place, but there was little agreement as to what those changes will look like.

Challenges of insurance exchanges

The formation of state insurance exchanges was a topic of much interest and debate. While the general concept was viewed as having potential, many challenges to successful implementation were identified.

These include a risk adjustment formulation that does not penalize plans that accept poor risk populations, the ability to provide good cost and quality information to consumers and having a structure in place that prevents employers from abandoning existing employee coverage.

Accountable care organizations discussed

The creation of ACOs was another topic of interest. Richard Umbdenstock, president and chief executive officer of the American Hospital Association, indicated that his member hospitals were actively purchasing medical groups to begin creating ACOs. Attendees were quick to point out the history of hospitals knowing very little about managing clinic-based care.

Medical home

The patient-centered primary care medical home was uniformly viewed as an essential model to preserve and enhance primary care delivery. Effective disease management of chronic illnesses was also viewed as an essential component of efficient health care delivery. These two concepts will likely go hand-in-hand.

Dr. Clancy indicated that funds from the recovery act were allocated for a Patient Centered Outcomes Institute.

IT system to link all parties

All attendees firmly agreed that an effective Internet technology system that links providers, patients and payers was an essential component of all of the reforms. In part, this IT system would need to provide transparency of information on quality and cost that gives consumers adequate tools to make good insurance and health care choices.

Most attendees viewed the elimination of lifetime caps and discrimination for pre-existing conditions as positive reforms. However, they pointed out that these will not work if the individual mandate is not effective. Current penalties for noncompliance with the individual mandate were viewed as being too light to provide effective compliance incentives.

Optometry must be involved

In summary, the NBCH annual conference was a well attended forum where exchange of diverse ideas on health care reform from the nation’s most informed health delivery experts stimulated a new awareness of the opportunities our health care system presents in the next decade.

Optometry will likely be affected by every topic discussed at this conference. In my opinion, the profession needs to be at the table to help craft our new health care system or we will be forced to live with the ideas of others.

• Greg Kraupa, OD, is a member of the Primary Care Optometry News Editorial Board. He can be reached at Eye Care Centers, 1965 11th Ave. East, Suite 101, Maplewood, MN 55109; (651) 777-3555; greg.kraupa@comcast.net.