Collective Action Can Make Impossible Things Happen in Healthcare

“Impossible things are happening every day,” and they are creating the window and the urgency to do something, said Elizabeth Mitchell, president and chief executive officer, Pacific Business Group on Health (PBGH), during her session at the National Alliance of Healthcare Purchasers Coalition’s 2019 Leadership Summits, held June 24-26 in Pittsburgh, Pennsylvania.

For so long in healthcare, everyone was seeing different sides of the same elephant and seeing different problems: The measures were wrong, incentives were not aligned, patients were not engaged, etc. The reality is that all of those problems exist, she said, and “it’s time to stop staring at the elephant….We have to act.”

The good news is that collectively, the different stakeholders can come together and share data and understanding on different issues to address these problems. But everyone has to work together to change the healthcare system.

“…We are only stronger together,” Mitchell said. “We need each other; we are all on the same journey. And the medical industrial complex and the status quo are only strengthened if we are divided.”

Everyone has known for a while that health spending as a share of gross domestic product is rising, and it will soon represent half of household income, but as the cost rises, the value of care is diminishing, Mitchell said. She advocated for investing in the things that actually make people’s lives better.

Moving forward, PBGH is focused on:

• Advancing primary care—a robust primary care base is necessary, and more money in primary care means less money is needed elsewhere
• Purchasing value—we have to pay higher quality care, but it isn’t possible in dysfunctional markets
• Creating functional markets—employers can’t pay for value if markets don’t function properly. This means getting rid of anticompetitive practices, gag clauses that prevent data sharing, and other barriers that prevent employers from purchasing value.

To advance primary care, PBGH is bringing health plans to the table to align them around advanced primary care with mental health integration. This is only taking place in California, but PBGH plans to share its learnings so that this can be scaled around the country.

The coalition is looking at an advanced primary care payment model and will define the measures of advanced primary care. Once those measures are identified, PBGH will be enlisting other employer coalitions to also use them. In addition, PBGH is trying to work with Adam Boehler, deputy administrator for innovation and quality and director of the Center for Medicare and Medicaid Innovation, because the agency is moving in the same direction.

“If we get the biggest purchaser of healthcare in the world [CMS] aligned with the private payers, we can really drive change,” Mitchell said.

PBGH is advancing quality and enabling value-based purchasing through partnerships with accountable care organizations, surveys, maternity care, and new payment models. In addition, PBGH has set up the Employers Centers of Excellence Network (ECEN). The coalition has been designing this network for several years, and it selects the quality metrics that it knows matters, such as patient experience and patient-reported outcomes.

Working with employer partners, PBGH selects a small number of facilities that will provide services a small number of services through ECEN.

Not only did patient care improve and outcomes improve, but patients were happier.

“Patients were coming back saying, ‘We did not know healthcare could be like this. This is the best experience of care we have ever had,’” Mitchell said.

She used one employer as an example to highlight the success of ECEN. Over just a few years, Walmart saved more than $1.9 million in total cost of care. It was paying more for services, but using a prospective bundle, it was avoiding readmissions, long-term care, and infections.

“[Walmart] actually got the win-win-win: reduced total cost of care [and improved patient experience] through better care delivery,” Mitchell said. “It can happen. It is happening.”

Through ECEN, the market is working, she added, because they are choosing the quality metrics that have to be met and only those facilities that meet the metrics can be included in the network.

Making changes like this requires someone to take the lead. Mitchell said that employers want to take part and join these efforts, but they often need someone to provide step-by-step instructions of how to do what is needed to get there.

“I think if we have enough leaders taking that risk, we’re going to make it easier for everyone else,” Mitchell said. “It’s our job at PBGH, and elsewhere, to quantify that. What does it take?”