MABGH

The Council of Accountable Physician Practices and the National Alliance of Healthcare Purchaser Coalitions worked together to create a series of listening sessions with employers and health care purchasers across the country to understand how employers make health care purchasing decisions, what they want for their employees and the barriers to direct, collaborative relationship between the buyers and providers of care. The results were compiled into a report which highlighted ways physicians and employers can more effectively collaborate to provide quality healthcare.

The National Alliance has a series of publications called Health Policy in Transit. We have included some of the most recent publications for your reference:

• The Department of Labor and Health and Human Services issued additional guidance on the Parity Law by establishing more robust compliance and enforcement. 
• This brief from the National Alliance summarizes pieces from the Health Care Provisions in the American Rescue Plan Act of 2021
• This brief focuses on the Consolidated Appropriations Act, which funded the government through September 30, 2021. The Act included approximately $900 billion in COVID relief, and several significant health care provisions.
• The National Alliance recorded a presentation of James Gelfand discussing what the Better Care Reconciliation Act of 2017 meant for healthcare, coverage and purchasers.
• This brief provides an analysis of potential policies that the National Alliance plans to monitor during the tenure of the Biden Administration.

The National Alliance of Healthcare Purchaser Coalitions, American Psychiatric Association, American Psychiatric Association Foundation Center for Workplace Mental Health, Bowman Family Foundation and Meadows Mental Health Policy Institute launched The Path Forward initiative with the goal of improving five established best practices of mental health and substance use care.

Consolidated Appropriations Act tools:

• The National Alliance has created an Overview of how CAA impacts Plan Sponsors responsibility for ensuring Parity in their Mental Health coverage and provision of services.
• The Path Forward has created this Model Data Request Form to help Plan Sponsors obtain accurate information on whether their Plan is compliant.
• The Minnesota Health Action Group created an Action Plan to help purchasers translate the results of their data into specific actions by their Plan to meet requirements of CAA and improve access to Mental Health Services.
• The Mental Health Association of Maryland has created an infographic making the case for parity clear.

Accelerating the Path Forward During Turbulent Times, The Case for Collaborative Care During Covid-19: The National Alliance put together a document promoting the use of the Collaborative Care Model as a method for providing more equitable and accessible mental health to all regardless of gender, employment, sexual orientation, etc. 

How do individuals with behavioral health conditions contribute to physical and total healthcare spending? The Path Forward commissioned this analysis of claims from over 21 commercially insured lives to quantify the impact of behavioral health on medical health spending.  The results are eye-opening, and point the need to address mental health to impact medical costs.

Mental Health: Accelerating Action for Parity and Peak Performance: This action brief from the National Alliance focuses on helping employers ensure that they are providing parity with appropriate and affordable access to quality mental health support that meet employees’ and their families’ needs. 

Well-being Initiative: The Wellbeing Initiative was designed to help organizations understand that mental, intellectual, spiritual, financial and social health care as important as an employee’s physical health. 

Mental Health Accelerating Action for Parity and Peak Performance: The National Alliance put together action steps for employers to help prioritize mental health and get employees the care they need.

Integrating Mental Health Services and Primary Care: The National Alliance put together an action brief highlighting the benefits of incorporating mental health with medical care services and further discusses the Collaborative Care Model (CoCM) as a method for delivering such care.

The North East Business Group on Health:

The North East Business Group on Health put together a resource called Digital Tools and Solutions for Mental Health: An Employer’s Guide. The purpose of this guide to help employers think about new ways to support the mental health of employees, including ways to utilize digital technologies increase access and affordability.

Midwest Business Group on Health:

A Community of Solutions: Jointly Addressing Mental Health: The Midwest Business Group on Health put together this resource for employers to address problems and create potential solutions to access and reimbursement for mental health care. 

Reducing Opioid Exposure After Surgery: This resource was developed for employers to help ensure employees have access to non-opioid therapies for post surgical pain.

Addressing Pain Management & Opioid Use/Abuse: The Midwest Business Group on Health put together a number of resources to guide employers in managing opioid use and abuse.

National Committee for Quality Assurance:

Act on the Facts: Care After Mental Health Hospitalizations: The National Committee for Quality Assurance (NCQA) and the National Alliance put together a resource using data from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) that highlights the variation in mental health care in the United States. 

Other Mental Health Resources:

How do individuals with behavioral health conditions contribute to physical and total healthcare spending? Millman evaluated 2017 commercial insurance data (21 million insured lives) to determine which characteristics are associated with highest levels of spending. 

Opiods and the Workplace: Kentuckiana Health Collaborative put together a resource to help employers play a more significant role in promoting, protecting and supporting the health and safety of their employees and their families when dealing with the opioid crisis.

National Health Alliance Resources on Health, Race and Equity

The National alliance put together a number of resources for employers including webinars, current event articles, journal articles and toolkits.

Equity in the Center:

Equity in the Center (EiC) works to shift mindsets, practices and systems in the social sector to center race equity and build a Race Equity Culture. One of the resources EiC put together includes Awake to Woke to Work Building a Race Equity Culture. It serves as a guide for employers to engage in race equity work.

This article from Employee Benefit Advisor, does a deep dive into employers, scrutinizing diversity efforts after national protesters demand change after the racial reckoning of 2020.

This Washington Post article discusses inequities in maternal mental health, mortality and morbidity and the impact the pandemic had on new black mothers.

The Patient-Centered Outcomes Research Institute is supporting clinical effectiveness research to further understand disparities, what they are, where they exist and how to overcome them.

The American Heart Association (AHA) developed an initiative that focuses on managing health and well-being at work. The AHA CEO Roundtable developed the Playbook titled Good Health is Good Business to help employers understand what works in workplace health, and design programs accordingly. 

The National Alliance put together a resource for employers on how to manage employee cardiovascular health, improve health outcomes and associated costs.

Given the overlap between the two diseases, the Midwest Business Group on Health (MGBH) put together a Diabetes and Cardiovascular health toolkit for employers to address the high rates of the two diseases among employees. The toolkit includes a number background, resources and strageties to lower risk factors and the prevalence of the diseases among employee populations.

The Midwest Business Group on Health put together a resource on the importance of employees being able to access and afford insulin in order to successfully manage their diabetes. The MBGH also provides a number of resources focusing on diabetes management in the workplace.

Racial and ethnic minorities, those who are of lower-socioeconomic status and less educated have a higher risk for developing type 2 diabetes. Once these groups become diabetic it is very hard manage the condition. The North East Business Group on Health (NEBGH) put together a resource for employers that focuses on the challenges this population experiences with diabetes and associated illnesses like cardiovascular disease and how employers can help.

Understanding the Science of Obesity is key to treating Obesity as a disease.  This Presentation by Dr. Domenica Rubino, Director of the Washington Center for Weight Management and Research, is a common-sense introduction to the physiology of Obesity, and how this condition is manifested in many other diseases.

This Action Brief by the National Alliance addresses barriers to effectively addressing obesity and provides solutions for employers. 

Addressing Obesity starts with an evidence-based benefit design.  The STOP Obesity Alliance has created this evidence-based set of Obesity Recommendations for that purpose.  These Slides explain the development of the recommendations.  Use this Checklist to align your benefits address Obesity effectively, and track codes to establish a benchmark, and track progress with their efforts.

Bariatric Surgery can play a role in effective Obesity management.  Click for this informative Action Brief addressing considerations for high-value Bariatric surgery.

Obesity affects many other conditions.  Purchasers should understand the true economic impact.  This Presentation explains how the different classes of Obesity also have different impacts on conditions ranging from heart failure to knee osteoarthritis, and the associated ICD codes that purchasers can use to understand that impact on their population. Milliman recently completed a study highlighting how costs of Obesity impact the commercial population.

The National Alliance developed an obesity initiative focused on working with number of stakeholders to address obesity. The goal of the initiative is to enact change through education, policy, population/community health and treatment.

The Patient-Centered Outcomes Research Institute (PCORI) funded 19 studies related to obesity. On the organization’s website readers can access a myriad of resources related to the studies.

The NEBGH put together a guide called Cancer Survivorship: Challenges and Opportunities for Employers. This guide includes a compilatiion of literature reviews, expert and cancer survivor interviews and collaborations with employers. And it is designed to create a workplace that supports cancer survivors.

The National Alliance put together an Oncology Initiative to provide coalitions and employers with successful strategies for supporting employees with their cancer care. The initiative includes strategies and best practices for championing cancer support in the workplace.

There have been advances in cancer care and with the advancement has come an increased cost of care. In order to help employers provide benefits and coverage that enable access to high quality cancer care and outcomes at a reasonable cost the National Alliance put together a resource along with other expert stakeholders to guide employers.

This resource from the National Alliance looks at research performed by PCORI that evaluated the frequency of testing/screening practices following surgery for colorectal cancer, addressing the question whether more frequent testing was better at spotting tumor recurrence than less frequent surveillance.

The National Alliance put together a resource for empoyers that examines what specifically drives people-centered outcomes and
organizational performance.

The National Alliance recorded a webinar and posted the associated slides for employers to better understand cannabis and how to improve the safety and health of employees.

This action brief by the National Alliance focuses on steps employers can take to ensure employers are getting high quality and not just high cost care when it comes to medical imaging.

This action brief by the National Alliance helps guide employers and employees understand which rheumatoid arthritis treatments and prescriptions are the best and most cost effective.

The Catalyst for Payment Reform has provided a number of resources on different quality topics. Employers can create an account to access the toolkits and resources at no charge.

The Center for Value Based Insurance Design (V-BID) is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID, based out of the University of Michigan, has put together a number of resources focusing on health care quality and costs. Please check out the following resources for more information on low value care and consumer cost sharing.

The National Alliance of Healthcare Purchaser Coalitions provides many resources on quality and cost, including this resource that explains the Choosing Wisely® initiative. Employers can use this resource to better understand the initiave and find tools to address unnecessary care and ways to improve quality, safety and efficiency. This second resource focuses on lowering costs by looking at biosimilar prescription drugs.

The National Committee for Quality Assurance (NCQA) put together a toolkit for employers to assess mandate and incentivize health plan quality. To access the free toolkit, provide your name, organization and email address.

Quality Compass
Responsible Agency: NCQA – Compilation
of managed care organization (MCO) data including NCQA’a accreditation
results and HEDIS (Healthplan Employer Data Information Set) http://www.ncqa.org/tabid/177/Default.aspx

Agency for Healthcare Research and Quality (AHRQ)
Committed to helping the Nation improve our health care system. To fulfill its mission, AHRQ conducts and supports a wide range of health services research. http://www.ahrq.gov/

Maryland Health Care Commission
An independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access in a rapidly changing health care environment by providing timely and accurate information on availability, cost, and quality of services to policy makers, purchasers, providers and the public. http://mhcc.maryland.gov/

Behavioral Risk Factor Surveillance System (BRFSS)
Responsible Agency: CDC/National Center for Chronic Disease Prevention and Health Promotion
BRFSS is an annual survey that asks respondents about a variety of diseases, including diabetes, as well as health behaviors. http://www.cdc.gov/brfss/

Health Care Utilization Project (HCUP) HCUPnet
Responsible Agency: AHRQ Center for Organization and Delivery Studies (CODS) Hospital discharge data from UB92s (all payers) submitted by states; now (2002) getting data from 29 states which represent 80% of all US hospital adms. http:/hcupnet.ahrq.gov/

NHANES III
Responsible Agency: CDC National survey with 3 data sets: 1) Self Reported 2) Medical Exam 3) Lab
http://www.cdc.gov/nchs/nhanes.htm

Centers for Medicare and Medicaid Services and State Quality Improvement Organizations (QIOs)
Responsible Agency: Delmarva Foundation (MD & DC) Virginia Health Quality Center (VA) Medicare claims data (inpatient, ED, outpatient hospital, physician office, home health agency, SNF); HbA1c testing is annual rate; eye exam and lipid profile are a biennial rate DC) http://www.dcqio.org/ 
Maryland) http://www.mdqio.org/  Virginia) http://www.vhqc.org/

Provider Recognition Program
Responsible Agency: National Committee for Quality Assurance -NCQA- Data obtained from medical record and patient survey)The Provider Recognition Program (PRP) recognizes physicians who meet the standards of diabetes care established by the program. The PRP performance indicators and outcomes measures represent consensus standards for appropriate treatment for diabetes patients. http://www.ncqa.org/tabid/74/Default.aspx

National Hospital Discharge Survey (NHDS)
Responsible Agency: CDC/ National Center for Health Statistics
NHDS is an annual review of a sample of hospital discharge records which includes demographic, diagnosis, and procedure data for each selected hospital admission. http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm

The National Alliance of Healthcare Purchaser Coalitions is addressing a number of topics affecting the pharmacy and medical side of benefits including contracting and formulary management, reducing waste, pharmacy benefit manager (PBM) performance, pricing inequity, personalized medicine, and value-based benefit design. This website provides background on the initiative as well as additional related resources to pharmacy benefit management.

The National Alliance’s 2020 Findings on the State of the PBM Industry report includes a sample of Pharmacy Benefit Managers (PBM), with large and small, “carve-out” and “carve-in” organizations demonstrating their commitment to transparency by answering questions on their policies and programs.

The National Alliance Medical Directory Advisory Council put together a framework to educate and advise employers on prescription drug value.

The Midwest Business Group on Health developed a report titled Precision Medicine in Pharmacy Design: Pharmacogenomics & Pharmacogenetics to help benefit leaders and consultants understand how individual’s genes affect their response to medications and how they are used within the pharmacy benefit for self-insured employers. The article also provides clinical and administrative guidance and action steps employers can take to best utilize Pharmacogenomic (PGx) testing.

The Midwest Business Group on Health and Mid-America Coalition on Health Care put together Considering Authorized Generics in Pharmacy Benefits Design, a resource designed to examine authorized generics (AG), how they can impact the marketplace and also provide guidance to employers so that AGs are covered under the pharmacy benefit.

The Pharmacy Benefit Management Institute (PBMI) put together a resource evaluating the unintended consequences of step therapy and prior authorization when it comes to utilization management.

The PBMI developed a resource guiding employers to look further into a proactive utilization management policy discussion. This resource outlines various considerations that employers should take into account when developing programs.