Neil Goldfarb on Launch, Value-Based Impact of Greater Philadelphia Business Coalition on Health

Business coalitions play a substantial role in driving health care value, and in the 10 years since I launched the Greater Philadelphia Business Coalition on Health (GPBCH), value-based improvements can be seen regarding availability of hospital safety data and growing adoption of diabetes and obesity initiatives among employers, said Neil Goldfarb, president and CEO of GPBCH.

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

Transcript

What motivated you 10 years ago to launch a business coalition in the Greater Philadelphia region?

I was a researcher in academia at Thomas Jefferson University and most of my career had been in quality measurement and improvement and health economics. I got very interested in the question of, what role do employers play or could play in driving value in health care? I started to do research, talking to employers, thought leaders, and other health care system stakeholders about what do you think about this new value-based purchasing movement we're hearing about? Do you think that will really drive meaningful improvements in the health care system?

Through those interviews, I came to be familiar with other regional business coalitions around the country that were bringing employers together to work on demanding more value from the health care system. Philadelphia did not have a business coalition on health, unlike many other major metropolitan markets. So, as I continued this research, I really came to believe that business coalitions play a crucial role in the health care system. In fact, my research suggested that of all the stakeholder groups that were working in health care, most key opinion leaders felt that employers had the most power to make change.

So, with that in mind, I left my position at Jefferson with the hopes of starting a business coalition on health for the Greater Philadelphia region. And I just started knocking on doors, meeting with employers who I'd met through my previous research, and got a few early large employers to sign on to this idea. Wawa was the very first employer to say, hey, if you do this we're in. And Comcast followed suit afterwards. When you have names like that behind you, other employers say, maybe this is viable, let's try to do this. So, that's really what motivated me—the idea that businesses coming together could demand more of the health care system and use their purchasing power to drive improvement.

What accomplishments have GPBCH had so far?

We announced our launch in 2012 with 8 employer members and today we have 50 employer members. So, I'm proud of that. Not that that's what we set out to do in terms of changing the health care system, but I think it represents success in terms of employers seeing the value of coming together through the coalition. And so I am proud of the fact that we've grown 5-fold over the past 10 years.

I'm also proud of some of the work that we've done. When we started the coalition, one of the first things I said to employers I met with was, did you know there's a national movement called the Leapfrog group that is trying to get hospitals to publicly disclose information on health care quality and safety at their facilities? And did you know that in our region, we have 55 hospitals and only 3 of them are reporting this data voluntarily to the Leapfrog group?

If we form a coalition, we can change that. We have the purchasing power, and we can ask the hospitals to participate and set expectations, as their customers, that they disclose their safety information publicly using the Leapfrog tool. So we had 3 out of 55 hospitals that were reporting Leapfrog data before we formed the coalition, and each year, that number has gone up. We're now at 78% of hospitals in the Greater Philadelphia region that are reporting data publicly. And that's an accomplishment.

Why it's important, why it's more than just a numbers game is, we know that when data is put out in the public space and is available for purchasers and consumers, it not only gives them that additional information to drive behavior, but it also [incentivizes] the hospitals to invest more in their own quality and safety improvement efforts. We've heard directly from many of the providers who now participate with the Leapfrog hospital survey that it’s helped them to identify deficiencies in patient safety and address those deficiencies, and in some cases, it's actually gotten them to get additional resources from the C-suite to support their quality improvement initiatives.

So we're really proud of that, that we've not only increased the transparency around patient safety, but we know that we've had improvement in patient safety at many of these facilities as a result of that public reporting. So, that's one major accomplishment that I'm very proud of.

I think another one is in the area of obesity and diabetes management. When we ask employers, what are your biggest health challenges, obesity and diabetes are always numbers 1 and 2 on that list in some order. And rightly so—50% of the population is overweight and obese, and over 10% of the population [has] diabetes, and both of those proportions are growing over time.

So, we have had a lot of success in bringing employees to the table to learn more about how to effectively support people with diabetes risk, prediabetes, through efforts like enrolling in the CDC’s National Diabetes Prevention Program. We've had, I think, 15 employers now implement that program for their workforce, and all of them have had success in helping people reduce their risk of developing diabetes, largely through weight loss. We've also promoted other things that employers can do through benefit design and through wellness programs to support people who have obesity or diabetes, such as value-based insurance design, lowering copays and coinsurance for diabetes drugs and devices, or waiving copays all together.

We have had success with getting several employers to pick up coverage of antiobesity medications in their pharmacy benefit plans. And this is a topic I'm really passionate about: that employers treat obesity differently than other chronic diseases. They don’t even ask twice, should I cover antihypertension drugs? Should I cover lipidemia drugs? But they have to be convinced to cover obesity drugs.

So, I'm very proud of the fact that we have been breaking down stigmas around obesity. It's not just lifestyle or that lifestyle clearly is a major driver. It's also genetics, it's also the built environment. And so as we break down that stigma around obesity and recognize it as a chronic disease, we've seen many employers focusing more on what they can do to create parity and benefits for obesity, like they did for many other common chronic diseases. So, I'm really proud of those as a couple of accomplishments for the coalition.