Neil Goldfarb Discusses Challenges and Future for Business Coalitions Driving Value-Based Care

Through the assistance of organizations such as the National Alliance of Healthcare Purchaser Coalitions, business coalitions are driving community-based and nationwide innovation in health outcomes, pricing, and value, but there remains significant challenges regarding transparency and support from community employers, said Neil Goldfarb, president and chief executive officer of Greater Philadelphia Business Coalition on Health (GPBCH).

GPBCH will be hosting a 10 year anniversary event on November 10, 2022.

Transcript

What have been the biggest challenges for GPBCH in advancing health care value?

I think one of the biggest challenges, as I alluded to when talking about the Leapfrog group, is the lack of transparency in the health care system. So, value is all about the relationship between quality and price, and many employers are faced with the challenge of not having good access to information on quality and not having good information on price.

So, as we have helped, as a coalition, [to] push the transparency agenda, not just for hospital care, but for other venues of care, we know that that has made a difference, but there's a lot more work to do. We don't have very good transparency, as an example, around physicians. We are very passionate about primary care being the keystone for an effectively performing health care system.

We don't have good information currently that's available publicly on which primary care providers offer good quality care. What are their outcomes looking like? What's the price for different services that are offered? How are the primary care providers being paid under different health plans? And so we have a lot more work to do. If we're going to drive value and use our purchasing power, we have to start with more transparency about exactly what we're buying and at what price. I think that's one of the biggest barriers.

I think the other big barrier is, it's great that we have been successful as a coalition in growing our membership, but for every member we have recruited, we've probably talked to 2 or 3 employers who have said, "I don't have time to be in a coalition," or, "I really get what I need from my benefits consultant," and who don't recognize the value of employers coming together and all rowing in the same direction through a coalition.

So, for anyone listening out there, who is an employer, if there's a regional coalition in your area, I would urge you to talk to them and to support them. Even if you can't go to meetings or educational programs, your coalitions are working on your behalf every day, and they are influencing policy, they are influencing quality in your market, they are implementing and improving safety measures, and that is benefiting your employees and your program. So, every employer owes it to their regional coalitions—not just GPBCH, but other coalitions around the country—employers owe it to show their support for those coalitions because those coalitions are greatly supporting them.

GPBCH and nearly 50 other regional coalitions are members of the National Alliance of Healthcare Purchaser Coalitions. How has that relationship helped your coalition advance its mission?

The National Alliance of Healthcare Purchaser Coalitions (National Alliance) is a national organization, we’re a member of as a regional coalition, and their mission is parallel to ours: Bringing coalitions together to work on the big issues in health care to hopefully help employers and their coalitions drive value. One of the key things the National Alliance does that I'm very appreciative of is, they bring all of us together collectively to learn from each other.

So, I have a staff of 2 other people. I can only take on so many projects at any one time. Other coalitions, our sister coalitions, are working on other important topics; some of them working on the same things we're doing, but many of them working on other topics. And the National Alliance brings us all together so we can learn from each other, we can adapt each other's tools and approaches to driving value, we can learn not only about successes, but also about failures so that we don't spend a lot of time replicating something that's unlikely to be successful. So, that's, for me, the biggest benefit of the National Alliance, that learning network.

The other piece of it is that the National Alliance is representing us on a national policy level. There is so much going on in Washington, DC, right now, as many viewers know, as well as in many states and localities regarding health policy, price control, access to care, surprise billing, all sorts of issues.

The National Alliance serves as a trusted source of information on what's new in the policy arena, what can we be thinking about, how policies might impact coalitions and their employer members, and provides an opportunity for us to sign off on many legislative letters advocating for policies in the interest of our employer members. And so the National Alliance for me is a really important resource that we can draw upon for information, knowledge, policy support, and working collaboratively with other coalitions to change the value of the health care system

As health care evolves, what is the future role of coalitions to manage the health of employees?

I think coalitions will always have a role to play. So, employer-sponsored health insurance doesn't seem to be going away anytime soon. And so employers are going to continue to be challenged by the increasing cost of health care, the continuing problem with lack of transparency, the need to influence the health care system, which they have a hard time doing on their own. Coalitions add value with an employer-sponsored health care system.

But even if employer-sponsored insurance was to go away, let's say the federal government said, "We're going to have Medicare for all," and the employers’ role is basically to go and support that through taxes, even then, employers still have to think about the health of their workforce. The workforce, not only the direct costs, but the indirect costs—loss of productivity, absenteeism and presenteeism, workers compensation claims, long-term and short-term disability claims.

And so, no matter what happens with the structure of the health care system, employers I believe need to remain in the game, at least on the workforce health side and community health side. And so, I'm not worried about the future of coalitions. I think they play a vital role and whatever happens with the health care system, we're always going to need watchdogs for quality and to make sure that quality isn't diminished to save some money.

So, I'm really proud of what we've done, and I think the future for coalitions is bright, and I would hope to see that they are able to increasingly demonstrate their direct impact on health outcomes and on pricing or value.