Who’s Still Working for You?: Business Group on Health

In a series of articles, PLANSPONSOR is checking in with industry groups to see what work they have done, and will do, for retirement and health plan sponsors as the pandemic continues and beyond.

Business Group on Health (the Business Group) has an extensive to-do list for the next few years, but what ties all of its priorities together, at least for a while, is the COVID-19 pandemic.

The Business Group’s mission is to be the global voice of large employers dedicated to finding innovative and forward-thinking solutions to the nation’s most pressing health care issues.

“The pandemic is the priority,” says Ellen Kelsay, the organization’s president and CEO. “I predict we will be dealing with that well into next year. Vaccines, boosters, [and] should employers mandate vaccines? The policy side of doing that? The issue of returning to the work site safely.”

At the top of the list, she says, is doing whatever is necessary to remind employees to get back to their doctors for routine checkups and screenings that may have been neglected since the pandemic first hit. To that end, the group educates employers and provides them with resources such as tip sheets and FAQ documents to share with their workers.

Certain issues have been priorities for the group for many years but stand out even more as needing to be addressed, due to COVID-19. One such need is for accelerating the move toward alternative payment and delivery models. The Business Group has responded to requests for comments made by regulators in this area, specifically as to pricing transparency requirements. “One such need is for accelerating the move toward alternative payment and delivery models. Traditional fee for service models incent volume but have little correlation to outcomes, to quality of patient experience,” Kelsay says. “There are many approaches to alternative payment and delivery models such as value-based payments and bundled payments.”

When it comes to tackling complex issues such as payment models, the composition of the Business Group makes it an effective catalyst, Kelsay says. “We can convene forums, get all of the stakeholders in a room—health plans, insurance companies, hospitals and doctor groups, consultants, employers. We convene these various stakeholder groups to collectively understand, address and advance on the most pressing health and well-being issues,” she says. Of the Business Group’s 440 member companies, approximately 75% are large employers with 10,000 or more workers, and the others are health industry partners, she says.

The pandemic has put the spotlight on two other areas of health care: mental health and telehealth, she notes. “Mental health is a top priority,” she says. “There are many efforts underway to expand access including ensuring that more providers are added to the networks and that mental and behavioral health services are more effectively integrated into primary care and other provider visits.”

Access to services can also grow through the use of telehealth, Kelsay adds. The Business Group has advocated for telehealth on Capitol Hill, in testifying about coverage, quality and licensing considerations.

Drug pricing is a perennial issue for the Business Group, but increasingly a priority since 2017, she says. “Regulations under discussion now center on government negotiation of prices, and we will share employer perspectives on that with congressional offices that might be sponsoring drug pricing legislation,” she says. “There are concerns that, if the government is negotiating pricing only for Medicare, drug companies will shift the cost to employers, who will pass it on to employees in their private health insurance.” She adds that the Business Group tells regulators it supports government involvement in negotiations, but it also warns them of the unintended consequences of a shift in costs to the commercial market.

The Business Group wrote a report on the pharmacy supply chain in the early stages of the pandemic, a year ago April. It cautioned employers that their pharmacy benefit could be affected in a number of ways by the emergence of COVID-19—anything from possible drug shortages, to countries stockpiling raw materials used for pharmaceuticals, to the off-label use of drugs thought to be effective in treating the coronavirus but not approved for that purpose. It urged employers to address these concerns with pharmacy benefit managers.

Kelsay says the group has made much more use of social media over the past year, as well as offering a podcast and blog, which are available to the public. “The pandemic has really underscored and magnified the need to continue to address the things we talk about,” she says, “[the need] to prioritize, and not squander the moment.”