KeepHealthCare.ORG – How employers can better negotiate with their healthcare partners
WASHINGTON — Employers can best navigate the current healthcare system by reviewing up-to-date medical information to stay ahead of the curve, panelists at the National Business Group on Health’s (NBGH) Business Health Agenda 2018 said. But is that easier said than done?
In today’s healthcare industry, where each player — vendor, insurer and medical provider — has their own agenda, employers must robustly represent their own needs as well as the needs of their associates and their associates’ families, Yvonne Frame, senior manager of U.S. benefits at Cerner, told the crowd. And to do that, employers need evidence.
Frame and Magda Rusinowski, director of U.S. benefits at PepsiCo, are members of the National Committee of Evidence-based Benefit Design (NCEBBD), an arm of NBGH that works to ensure that employers have access to insights on the most cutting-edge research in the medical space. The committee aims to fill a key gap: giving health benefits professionals the ability to support their arguments with medical knowledge without having to rely completely on medical consulting services.
That clinical knowledge can change how a benefits professional is viewed within these discussions. “Knowledge is an equalizer,” Rusinowski said, and it can “put employers back in charge” of the conversation around medical benefits and what’s best for your employee base.
The realm of medical data moves both with lightning speed and sloth-level caution. While there are thousands of new trials each year, it can take upward of 17 years for findings through research trials to reach clinical practice, Dylan Landers-Nelson, manager of the healthcare cost and delivery institute at NBGH, told the crowd. And then it can take even longer for doctors and providers to actually implement the new data into their practice.
Employers no longer have to sit by and wait. Increasingly, top employers are using their weight to force change and lower costs; similarly, companies can go directly to the source of the research themselves and bring that knowledge to their negotiations with providers.
Employers have a few tools at their disposal for implementing that data, Landers-Nelson said, but most or all require solid relationships with insurers and providers based in strong, data-driven conversations:
Coverage decisions. Cover things that evidence says helps. Don’t cover what’s unnecessary or not shown to be useful.
Plan design incentives. Make it easy to access the best, most valuable care.
Network design. Incorporate the best providers up on the evidence.
Healthcare provider partnerships. Centers of Excellence (CoEs) remain a powerful way to stay ahead of the curve.
Vendor partnerships. Be aware of who you partner with and why.
Employers have limited time to explore the emerging data on their own, Rusinowski said. The NCEBBD aims to be a partner with busy employers, flagging changes in medical research that may be relevant — and, hopefully, catching coming trends in medication or healthcare tactics before they start driving medical spend sky high.