The National Business Group on Health tracks the health care-related concerns of very large employers. It is influential and its views worth following. In a recent blog post, the organization listed 6 issues it is watching for 2017. (NBGH Post) The first is the rather obvious uncertainty about what will happen to the reform law and if all or part is repealed, what, if anything, might replace it. It is worth recalling again that the ACA is a massive piece of legislation affecting just about everything in health care. Many parts are pretty uncontroversial. It is the coverage provisions and particularly the individual mandate coupled with exchange policies, that are most at risk. From a large company perspective, the employer mandate and certain taxes are of highest concern, and the mandate is largely irrelevant to these firms, since they all offer health benefits. In reality, the reform law and its possible repeal were and are largely irrelevant to these big companies. The next issue is use of value-based payments and whether the ACA debate will affect momentum. One thing large firms are very worried about is the continued rise in health spending. So-called value-based payments seem like a way to slow that, but the reality, I think, is that even if they lead to more rational care, they won’t reduce provider unit prices, they might actually increase them.
Next up on the NBGH list is what happens to the mega health plan mergers. We already know, as of today, that Humana/Aetna has been rejected on antitrust grounds. I expect the same for Anthem/Cigna, and justifiably so. But again, I don’t think these really affect large employers. Drug pricing of course makes the list. These large firms have been dependent on PBMs to help them control drug costs and I suspect frustration is boiling over. I would expect large employers to be looking for a different mechanism to control specialty drug costs in particular. Consumer engagement is an ongoing large company theme. They believe that if they get employees engaged in health, not only will spending drop, but productivity will improve. They just don’t feel they have found the best tools yet. Finally, on a related note, NBGH says firms are focused on total workforce well-being. Sounds good, but will actions match words. Want to reduce stress and improve satisfaction–reduce premium sharing and cost-sharing in health benefits.