Countless individuals in the U.S. are fortunate to receive healthcare via their employers. There is no magical, one-size fits all program though for employers to provide for their employees. Instead, employers often shop around the private market seeking the right fit for their company. This leads to the weighing of a myriad of offerings against one another while leaders attempt to choose the best fit to create a complete healthcare experience for their employees.
Employers are increasingly realizing however that they do not need to travel down this road alone. The Northeast Business Group on Health (NEBGH) is an organization that is helping unite employers together to discuss plan coverage, and the actual needs of their employees, in hopes of improving the quality of healthcare for many Americans.
Based in the Financial District of Manhattan, the President & CEO of NEBGH, Laurel Pickering, has been working to transform the healthcare experience on both a regional and national level. She has been encouraging employer members to ask themselves, "Shouldn’t you make sure you’re getting the most value out of each healthcare dollar you spend?".
By leveraging the collective purchasing power of their employer-led coalition, NEBGH has been able to make strides in improving healthcare delivery throughout the Northeast Region.
Laurel sat down with us to describe in detail some of the most pressing concerns that their members are facing when it comes to providing healthcare coverage and also the current projects that NEBGH has undertaken in partnership with New York State's new Advanced Primary Care Model.
Junto Health (JH): Can you briefly describe what led to the initial foundation of the Northeast Business Group on Health and what your mission is today?
Laurel Pickering (LP): Northeast Business Group on Health was originally New York Business Group on Health and later expanded to include New Jersey, Connecticut and Massachusetts. It was founded more than 25 years ago based on the idea that employers – through which half of all people in the U.S. get healthcare – could band together to improve healthcare quality and better manage costs. There are 50 or so such local and regional employer-led coalitions around the country, and all belong to an umbrella organization called the National Alliance of Healthcare Purchaser Coalitions.
Northeast Business Group on Health’s mission is: Empowering our members to drive excellence in health and achieve the highest value in healthcare delivery and the consumer experience. We help our members manage the healthcare benefits they provide to employees via information, education and resources, and also leverage their collective purchasing power to foster improvements in the healthcare delivery system – to transform it into a more rational, value-based system for everyone.
JH: Who makes up the membership of your organization?
LP: Northeast Business Group on Health is an employer-led coalition, but also includes national and regional health plans, hospital systems, benefit consultants and other healthcare stakeholders such as pharmaceutical companies and innovative providers of healthcare technology and other products and services. A majority of our board of directors must be comprised of employers, according to our by-laws. Membership includes 80 employers – primarily large national and global companies which are headquartered in the New York City metropolitan region – spanning a wide array of industries, including finance, media, consumer products and technology. New York City Office of Labor Relations – which provides healthcare benefits to more than one million NYC employees, dependents and retirees – is also a member.
JH: What current priority areas and projects are you tackling with your members?
LP: Current priority areas and projects we are currently tackling with our members include:
Mental health: We have a number of ongoing initiatives in this area, and in July, presented a half-day conference for members specifically on prescription drug abuse. We are initiating working sessions with health plans and employers to develop ways of expanding employee access to psychiatrists that are in-network for health plans – many psychiatrists, especially in NYC, will not accept in-network reimbursement and therefore are out of reach for employees, resulting in a shortage of available specialists for those who need help. We partner with a number of organizations including NAMI NYC Metro, The Kennedy Forum, Thrive NYC, Partnership for Workplace Mental Health and many others, to expand the number and breadth of mental health resources available.
Musculoskeletal disorders: We will soon release a report highlighting innovative workplace approaches to preventing and addressing musculoskeletal disorders including online ergonomics training, onsite physical therapy and high-value surgical bundles for joint replacements – an outgrowth of our work in this area.
Cancer: We are in year three of a multi-year project on cancer; previous years’ work has focused on employers’ views on cancer and the workplace, defining “quality” when it comes to cancer care, and recognizing and providing high-value cancer care. This year’s focus is the cancer patient “journey” – mapping this out from prevention and pre-diagnosis, to diagnosis, treatment and back to work or end of life – focusing on theclinical component, the emotional and social component and the benefits component (navigating health insurance, disability and the like). We will provide employers with guidance when it comes to understanding and addressing these components in a practical guide, with video components.
Caregiving: Caregiving is emerging as an increasingly important concern for employers as more and more employees are in the position of providing some type of care for family members while also working a full-time job. The impact of caregiving is significant on caregivers themselves in terms of their physical and emotional health and wellbeing, and on employers, in terms of absenteeism, presenteeism and employee morale. Innovative employers are finding ways of supporting employee-caregivers, and we will be highlighting some of these in a forthcoming practical guide for employers. In July, we released a benchmarking survey, detailing the perspectives and practices of 130 employers when it comes to the issue of caregiving. We are collaborating with AARP on this work.
Maternity health and C-sections: We are working on developing and rolling out a maternity measures scorecard, available online and via mobile devices, to help pregnant women in NYC and Long Island choose hospitals for their deliveries according to measures such as C-section rates, episiotomy rates, breast feeding friendliness and others. Where women deliver their babies matters – for both the women and their babies! Educating women and providing transparent information will empower them to make more informed choices now and for future healthcare decisions. Creating better, more informed healthcare consumers is a priority for the New York State Healthcare Foundation, which is funding this project.
In a related vein, we are also working on a pilot with Mount Sinai Health System and New York City Office of Labor Relations to reduce the rate of C-sections among NYC employees who deliver at Mount Sinai hospitals. The current rate of C-sections is too high throughout the state and nationwide, and we hope this pilot, if successful, can be extended to other hospital systems.
JH: How are you supporting New York State’s forthcoming rollout of a new Advanced Primary Care (APC) model? Can you give us any details on what this model will look like and how you are helping shape it?
LP: Our involvement in New York State’s forthcoming rollout of a new Advanced Primary Care (APC) model is a key priority for us! Two and a half years ago, we were chosen by New York State’s Department of Health to play a key role as an impartial convener of health plans, employers, providers and other stakeholders around the state to gather input and seek alignment and buy-in on a value-based model for delivery and payment of primary care. The idea is that over the next several years, an increasing percentage of NYS residents will receive healthcare via this APC model. Our recruitment in this effort was a result of our success in bringing multiple stakeholders together to develop approaches to conditions such as diabetes and obesity, and to issues such as hospital readmissions and ineffective approaches to the treatment of depression.
This is a statewide effort with a regional approach – there are several multi-stakeholder governing bodies developing implementation plans in several regions of the state, and NEBGH is leading these efforts together with NYS DOH in New York City and the Capital District/Hudson Valley. Already, NYS DOH is making funding available to primary care practices so that they can “qualify” as APC providers, which has requirements such as implementation of electronic medical records, extended hours, availability of care coordination for chronic conditions like diabetes, integration of mental health care with primary care, and more – requirements that are not dissimilar to the Patient-Centered Medical Home (PCMH) model already working effectively in many areas around the country as well as in selected areas in NYS. NYS received a $100 million, four-year grant from the federal government for this “State Innovation Model” project.
JH: There is a great deal of uncertainty today around the future cost, and even format, of healthcare in the United States. What are the biggest concerns that you have heard from you members regarding this uncertainty? What are you telling them?
LP: The biggest concerns we have heard from members regarding the uncertainty around the future cost and format of healthcare in the U.S. are the uncertainty itself (How do we plan ahead if we don’t know what the rules and requirements for employer-sponsored healthcare will be?), the possibility of a reduction or elimination of the Medicaid expansion (Will the cost of providing care for more uninsured people fall on the backs of employers via higher hospital fees?), and the ever-increasing cost of healthcare (With all the debate about insurance and access to healthcare, is anyone focused on attacking the root causes of this country’s expensive system?). We focus on doing what we can to influence the quality and cost of care in the healthcare delivery system, and on educating and informing our members about what’s happening in Washington via our programs and webinars.
JH: What are your top three goals for the rest of the year?
LP: Our top three goals for the rest of this year are increasing momentum among all stakeholders on advanced primary care, gaining traction on solving the problem of access to psychiatrists, and delivering practical guidance to employers in the areas of cancer and caregiving.
In five years’ time, we see NEBGH and the country headed toward a system that is accountable for the quality, cost and outcomes of care. Our role will be to engage all stakeholders, with employers in the lead, so that consumers can choose the right care at the right price and providers can offer high quality, affordable care. NEBGH will spearhead initiatives which focus on quality and cost problems in the healthcare system that are not being addressed by other employer partners/stakeholders, in some cases because they’re not incentivized to do so.