In the evolving landscape of healthcare procurement, employers are increasingly being held accountable for ensuring optimal medical benefits for their employees, while grappling with data accessibility challenges. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), stressed in a recent discussion that transparency in healthcare data is now a fundamental expectation for employers—a notion solidified by the Consolidated Appropriations Act of 2021. This legislation mandates that employers have greater access to healthcare claims data and prohibits agreements with third-party administrators (TPAs) that curtail such access.
Mitchell highlighted the situation, noting, “[Employers] are having more and more accountability placed on them as purchasers, with less and less responsiveness from the industry.” This sentiment reflects the growing concern among employers about making informed healthcare procurement decisions, which necessitates contracting with high-value providers who offer quality services at competitive prices. A concrete example of the complications arising from restricted data access is the ongoing Kraft Heinz vs. Aetna case, which underscores the challenges employers face when TPAs selectively provide data.
Furthermore, Mitchell suggested that PBGH is addressing these challenges by establishing a data initiative. This initiative aims to leverage the newly accessible data under the Act, combining it with claims data to pinpoint top-performing providers across various regions. Mitchell emphasized that this proactive data utilization could fortify employers’ fiduciary roles. “Even taking the step of using their data is protective from a fiduciary standpoint, because they are taking big steps to ensure that they are effectively spending the money,” she explained.
The repercussions of not fulfilling fiduciary duties have begun to surface, with employees increasingly resorting to litigation against employers. This was notably seen in a lawsuit against Johnson & Johnson for alleged overpayments on prescription drugs. Mitchell warns this could be a precursor to a surge in similar lawsuits, further raising the stakes for employers and their executive teams, who face personal liabilities.
Mitchell also mentioned a growing interest in direct contracting arrangements, where employers contract directly with physician groups, potentially reducing costs and improving healthcare outcomes and access. PBGH is advancing these dialogues with Congress, advocating for enhanced roles and responsibilities in fiduciary contexts and emphasizing the need for transparency and accountability from intermediaries such as third-party administrators and pharmacy benefit managers.
For more information on Mitchell’s perspectives and insights from the recent interview, visit the original article.