Purchaser Business Group on Health (PBGH)

It was an honor to give testimony before the Senate Committee on Aging on the critical issue of transparency in healthcare. I started with an analogy: Imagine being the CFO of a company where you hand over the company credit card to your vendors and supplies, and at the end of the month you are given a bill—no receipts, no details, just one lump sum. This is the reality in our healthcare system today, where employers are forced by their TPA's to pledge their dollars and their employees' to an unaccountable and unaffordable healthcare system with ZERO accountability or oversight. Abuse of the company credit card must stop. Here are a few key points from my testimony: Transparency: Employers and unions responsible for the healthcare of nearly 160 million Americans face a severe lack of transparency. This impacts the cost and quality of care they can provide. Real Impact: In New Jersey, over 200 school positions will be eliminated this year due budget constraints largely driven by healthcare costs, and public safety workers face a 16% premium hike, stretching already scarce resources. ERISA Compliance: Employers need access to transparent information to fulfill their fiduciary duties under ERISA. Without it, they can't protect their plan participants and beneficiaries. Employers are Paying for a False Discount: At Mayo Clinic in Jacksonville, a procedure costs $2,516 with FEBHP BCBS coverage but only $392.60 if paid in cash. Similarly, an ACL repair at University of Pennsylvania Hospital costs $37,489.74 with TRICARE, compared to $9,523.36 in cash. Misaligned Incentives: Third-party administrators (TPAs) often overpay for claims or make errors, and then charge employers 25-50% of the recovered payment to correct their own mistakes. Fox guarding the henhouse? Egregious Fees: Recently unsealed court documents revealed a group health plan paying $4,078,652.42 for a claim, while the provider received only $875,809.76. Cigna kept over $2.5M in fees and Multiplan pocketed over $677k. I gave these examples to highlight just a bit of the waste, abuse, and inefficiencies in the current market. When asked whether employers were still having issues accessing their claims data, despite passage of the CAA, I didn't hold back. I outlined how I have personally seen carriers have continued to deprive employers of meaningful access. If we expect employers and unions to exert any market forces to reign in healthcare costs, we must empower them with actionable data and transparent pricing. Patient Rights AdvocateFamilies USAMarilyn BartlettNational Alliance of Healthcare Purchaser CoalitionsPurchaser Business Group on Health (PBGH)Darren FogartyRanda DeatonShawn GremmingerMichael ThompsonChris SkisakHealth Transformation AllianceDave Chase, Health Rosetta-discovering archaeologistM.P.H.Ge BaiPreston AlexanderEric Bricker, MDPeter HayesChristine CastelliJulia PosackiBrook WestTy ArlintJeffrey HoganLee LewisAl Lewis 🇺🇦Brian Klepper

Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. What we don’t always agree on is what to do. We throw around lots of possible solutions from better consumer shopping to price transparency. But do they make a difference? Meanwhile the problem gets worse. Healthcare eats up almost 20% of our GDP while life expectancy and outcomes decline or stay stagnant. Clearly something has to change. California is the latest state to tackle healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health (PBGH)  – joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. 🎙Listen here: https://lnkd.in/dJiZ6HR9 🎙Or wherever you access podcasts: https://lnkd.in/eyjzAH68 Take a look at this great snippet where Elizabeth asks whether a 3% target is really enough.

I’m very proud of our Purchaser Business Group on Health (PBGH) members that are championing Advanced Primary Care everywhere. Yesterday marked an incredible achievement by the Washington State Health Care Authority in celebrating the signing of a Multi-Payer Collaborative Memorandum of Understanding, where 10 different payers in Washington State committed to working together towards Advanced Primary Care through advanced payment models and supports for primary care practices. I’m lucky to be able to work with great allies and amazing leaders who share my passion for improving our struggling primary care system. I know by working together and approaching this from our various perspectives and angles, we will succeed in ensuring our communities have access to high quality Advanced Primary Care to improve health outcomes, patient experience, health care worker experience, health equity, and health care spend efficiency. Congratulations Judy Zerzan-Thul and your team!!! Thanks Michele Ritala for representing purchasers and employers and sharing why primary care matters!