The National Business Group on Health’s mission is to be the national voice of large employers dedicated to finding innovative and forward-thinking solutions to the nation’s most important health care issues.
Brian Marcotte, president and CEO of the National Business Group on Health (NBGH) in Washington, D.C., says the group started in 1974 around the time of the passage of the Employee Retirement Income Security Act (ERISA) and as a result of the new legislation. “Employers felt they needed a seat at the table in Washington for health care and health policy issues,” he says. “They formed a group called the Washington Business Group on Health, which officially became the NBGH in 2003.”
Group members comprise large, typically self-insured, multi-state and even global employers, according to Marcotte, and they provide benefits to more than 50 million employees and covered dependents.
Plan Sponsor Interests
“While legislative and regulatory advocacy is part of our mission, we are much more than that,” Marcotte says. “We do limited lobbying because we are not a lobbying group.” According to the NBGH website, key objectives of the group include providing practical business solutions for health care cost management, including identifying and promoting best practices among large employers; where practical solutions do not exist, providing a forum for members and others to come together to create new solutions and learn from each other; promoting a forward-thinking point of view on current and future health care issues on behalf of large employers; and actively educating members and others about health care issues that might not be obvious today but may have important ramifications in the future, among other things.
“From a policy perspective, we provide advice and resources about the implications of proposed policy and regulations, and about what it takes to comply,” Marcotte says. “We also provide forums for members to share best practices, especially around compliance and administration, where members who have already implemented processes and are doing things efficiently can talk to other members.”
How the NBGH Advocates
The NBGH responds to requests for comments from regulators and sends letters to Congress providing data to legislators about what employers are doing as well as the implications of laws and regulations to employers. “ We have provided comment letters on issues concerning ERISA, the Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act (HIPAA), the Americans With Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), explaining the administrative burdens, unintended consequences and costs for employers to implement proposed rules,” Marcotte notes.
Among the successes the NBGH counts as part of its efforts is its work to delay the ACA’s excise tax on high-cost health plans (also called the Cadillac tax), and it continues its efforts to repeal the Cadillac tax.
Marcotte says the group has also successfully worked to establish the Medicare prescription drug benefit, including subsidies for employers that offer health benefits for retirees. The group played a key role in bringing consumers and providers together to pass Patient Safety Legislation to encourage transparency by making sure hospitals and clinicians that reported errors were protected from discovery in legal suits.
Recently, the group influenced more streamlined requirements in wake of the ACA for reviews, claims denials and reporting for COBRA. In relation to wellness program regulations, the NBGH advocated for incentives, workable rules and clarity for sponsors about proposed ADA regulations. It also advocated for alignment of GINA rules with the HIPAA wellness program standards.
Marcotte says the group’s highest focuses now are repealing or further delaying the Cadillac tax and creating more flexibility for health savings accounts (HSAs).
Resources the NBGH Provides
NBGH provides a number of resources and forums to help companies optimize business performance through health improvement, innovation and health care management. NBGH’s work on Accountable Care Organizations (ACOs) is one example. To help employers control health benefit costs, there has been a shift in strategy by employers to move away from fee-for-service to alternative payment models, such as ACOs, centers of excellence and high performance networks, Marcotte notes.
An ACO is a health care delivery model where health care providers come together to assume responsibility for the care and the cost of a defined population. Employers can either contract directly with ACOs or work through their health insurance company. More mature ACOs will typically share in the savings as well as the costs if the total cost of care beats or exceeds agreed upon targets.
Given the hundreds of ACOs available today to employers and how their structure and capabilities vary within markets and from market-to-market, the NBGH released two new tools designed to help employers understand and evaluate ACOs.
The group also hosts more than fifty webinars throughout the year about everything from health care policy, to company initiatives on well-being, to pharmacy management, and innovative start-ups. “After the ACA was passed, we had a series of ACA boot camp webinars,” Marcotte says. “We took members though all the provisions of the legislation, what they meant for employers, how to comply, best practices to comply, timeframe for compliance and what other employers are doing. This is an example of how we try to always offer timely, relevant and actionable solutions to our members.”
Research is a big part of what the NBGH provides. “We do a lot of survey work, including an annual health care strategy and plan design survey with members,” Marcotte notes. “We field an annual survey in June and produce the survey report in August. It gives members and the health care industry a good sense of what is to come in the next year from the large employer perspective.”
The NBGH also does research with industry partners, such as a survey with Welltok about wellness programs.
According to Marcotte, several years ago, the NBGH introduced a page on its website called Numbers You Need. “It’s a set of pre-packaged data and statistics in easily downloadable informatics based on data from surveys we’ve done and outside research,” he says. Categories include U.S. Health Care Costs, Consumer-Directed Health Plans, Well-Being, Pharmacy, Retiree Health, Public Policy and others.
“If employers can’t find the information they want there, they can call us and we can do a quick survey of members—we do about 40 or so of those a year,” Marcotte says. “For example, we can do a survey about what employers are doing about autism benefits. We ask five or 10 questions and quickly turn back out results.” He adds, that the group is now doing such a survey about what large employers are doing about Hurricane Harvey—what financial support and leave support employers are providing, what corporate giving is being provided. Employers can see what others are doing to get ideas and formulate their own strategies.”
Marcotte also notes the NBGH is a convener of ideas. The group brings thought leaders together to advance health innovation and improve how health care is delivered and paid for in this country. The group convenes members in a number of ways. There are small groups of members (20 to 30) concentrated on certain things—evidence-based plan design, pharmacy management and value purchasing. There are structured institutes on wellbeing in relation to workforce strategy, health care costs, and health and productivity, which convene between 30 and 50 members.
There are also larger ways of convening. The group hosts summits about a particular topic each year which gathers 75 to 100 employers and two annual conferences that attract between 500 and 600 attendees. “We are holding a summit in February about prescription drug management and the pharmaceutical supply chain,” Marcotte says. “It will take a deep dive into understanding how money and drugs flow through the system from pharmaceutical manufacturers all the way down to physician prescribing and some of the challenges around the whole model.” This year, the group did a deep dive about mental and emotional health, including challenges around access to mental health benefits, the stigma of mental health issues and peer identification training to help employees recognize symptoms and direct peers to resources in the company.
“Every January, we bring about 100 employers together here in D.C. to discuss what they did in the prior year, what they implemented in the current year and to strategically think about what to do in the next year and beyond,” Marcotte says. “We look at who’s doing what, what is working and not working and how to accelerate improvements in a fragmented delivery system.”
The NBGH also has a health innovations forum, in which about 30 to 40 employers get together and vet startups that may be able to disrupt health care in a positive way. “They come together to assess and possibly pilot startups, and if they have good results, we share their experiences with the broader membership,” Marcotte explains. “We’ve seen really cool innovations around engagement, diabetes management and transparency. We try to help accelerate these in the industry.”
Finally, Marcotte notes that many of the NBGH’s members are global, so there is a global business group as well. It focuses on how to help employers address global health issues and manage global benefits. There are about 80 members involved in that organization. Members share their experiences and the Business Group builds country profiles to help employers navigate the landscape. “Some may be strong in one country and know the market very well, but no company is strong in all countries, so there is tremendous opportunity to learn from each other. If an employer is establishing a presence in a country in which they are not familiar, they can get insight from another member that has experience in that country. They also work together to drive country-specific initiatives as a group,” Marcotte says.