Employer Provider Council (EPC)

Interested in where commercial insurance healthcare benefits are headed?

Have you registered to Join the upcoming EPC Conversations? The Employer Provider Council [EPC] is committed to building a more business friendly, equitable and sustainable healthcare system. We've hosted events like the WellSpent Forum and Linking Business and Healthcare to facilitate dialogue and drive progress. In addition, publications or presentations by EPC leaders and collaborative partners or coalitions aid in getting a message out, gain feedback, and continually improve the ability to make change happen that is beneficial. Upcoming Events: Employer Healthcare Town Halls (Georgia & South Carolina): We're holding meetings in Georgia (March 20, 2025) and South Carolina (March 19, 2025) to hear from employers, providers, consultants, and organizational leaders about the current state of employer-sponsored healthcare. Share your thoughts on what's working, what needs improvement, and potential solutions. Georgia Registration Link 3/20 https://lnkd.in/ejf-6hR7 South Carolina Registration Link 3/19 https://lnkd.in/eChSyXae We encourage you to connect with EPC to learn more, Visit https://epcouncil.org. ?? Let's work together to ensure your employees, communities, and families have access to the best possible care. #healthcare #employers #advancedmedicaltreatments #equity #costmanagement #riskmanagement #HQF #EmployerProviderCouncil #EPC #collaboration #innovation #WellSpentForum #LinkingBusinessandHealthcare #cancercare #employeewellness #GeorgiaHealthcare #SouthCarolinaHealthcare

?? New Episode Drop: Policy and Power - Dismantling Middleman Dominance in Healthcare ?? ?? ?? Co-hosts Randy Vogenberg, PhD and Michael Navin drop many truth bombs while elaborating on pivotal healthcare policy changes under the Trump administration. ??? https://lnkd.in/es5kgCMj #healthcare #policy #healthcarestakeholders #makeamericahealthyagain #pbmreform #changehealthcare #trumpadministration #podcast #onlyhealthcarepodcast

Have you registered to Join the upcoming EPC Conversations? The Employer Provider Council [EPC] is committed to building a more business friendly, equitable and sustainable healthcare system. We've hosted events like the WellSpent Forum and Linking Business and Healthcare to facilitate dialogue and drive progress. In addition, publications or presentations by EPC leaders and collaborative partners or coalitions aid in getting a message out, gain feedback, and continually improve the ability to make change happen that is beneficial. Upcoming Events: Employer Healthcare Town Halls (Georgia & South Carolina): We're holding meetings in Georgia (March 20, 2025) and South Carolina (March 19, 2025) to hear from employers, providers, consultants, and organizational leaders about the current state of employer-sponsored healthcare. Share your thoughts on what's working, what needs improvement, and potential solutions. Georgia Registration Link 3/20 https://lnkd.in/ejf-6hR7 South Carolina Registration Link 3/19 https://lnkd.in/eChSyXae We encourage you to connect with EPC to learn more, Visit https://epcouncil.org. ?? Let's work together to ensure your employees, communities, and families have access to the best possible care. #healthcare #employers #advancedmedicaltreatments #equity #costmanagement #riskmanagement #HQF #EmployerProviderCouncil #EPC #collaboration #innovation #WellSpentForum #LinkingBusinessandHealthcare #cancercare #employeewellness #GeorgiaHealthcare #SouthCarolinaHealthcare

?? New Episode Drop: Policy and Power - Dismantling Middleman Dominance in Healthcare ?? ?? ?? Co-hosts Randy Vogenberg, PhD and Michael Navin drop many truth bombs while elaborating on pivotal healthcare policy changes under the Trump administration. ??? https://lnkd.in/es5kgCMj #healthcare #policy #healthcarestakeholders #makeamericahealthyagain #pbmreform #changehealthcare #trumpadministration #podcast #onlyhealthcarepodcast

GLP-1 CARVE OUTS AND MENTAL HEALTH PARITY, HIPAA, AND EMPLOYEE DEMAND A handful of major carriers are reporting substantial losses in 2024, citing the cost of GLP-1 drugs (see, e.g., “BCBS Massachusetts reports $400M loss driven by GLP-1 spending,” Becker’s Payer Issues, https://lnkd.in/eqzcsTuy.) These losses will inevitably call even more attention to the GLP-1 spending by employer-sponsored group health plans. Not that more attention is needed. Employers are already painfully aware of the problem. ? There are a host of strategies being marketed to employers aiming to manage their plans’ GLP-1 spend, including adopting utilization control measures (e.g., prior authorization, step therapy, etc.). In addition, specialty carve out vendors seek to hack the drug supply chain using drug fulfillment alternatives and by limiting GLP-1 and/or other weight-loss medication to weight loss or diabetes. The problem is the some of the most popular approaches raise some basic compliance issues. One of the most common, limiting coverage of GLP-1 to medical conditions such as a diagnosis of diabetes or the need to reduce weight for purely medical reasons, likely violates the mental health parity rules. Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, are mental health conditions under generally recognized independent standards of current medical practice. The exclusion for certain treatments for a mental health condition are considered non-quantitative treatment limitations (NQTLs). Another popular alternative is to cover GLP-1 drugs for weight loss purposes only after the covered person completes a weight loss program. This raises issues under HIPAA health care non-discrimination rules, since a health plan cannot establish rules for eligibility based on an individual’s health status or medical condition. One approach that may work – for now at least – is to impose a lifetime limit (e.g., $25,000) on GLP-1 drugs, that does not depend on the reason for the drug being prescribed. Group health plans subject to the Affordable Care Act may not impose annual or lifetime limits on essential health benefits. Self-funded plans in particular have a good deal of flexibility on determining whether a prescription drug is an essential health benefit (EHB). (Regulations were proposed during the Biden administration that would treat all prescription drugs as essential health benefits. Given the current administration’s antipathy toward anything the done during the Biden administration, it seems unlikely that this rule will be adopted in final form.) But even if this approach works, it may as a practical matter be so unpopular as to make it less than useful.?

?? New Episode Drop: Policy and Power - Dismantling Middleman Dominance in Healthcare ?? ?? ?? Co-hosts Randy Vogenberg, PhD and Michael Navin drop many truth bombs while elaborating on pivotal healthcare policy changes under the Trump administration. ??? https://lnkd.in/es5kgCMj #healthcare #policy #healthcarestakeholders #makeamericahealthyagain #pbmreform #changehealthcare #trumpadministration #podcast #onlyhealthcarepodcast

Navigating the Complex Healthcare Landscape: A Message from the Employer Provider Council, February 2025 It's great to be back with this abbreviated newsletter as we have been quite busy with the kickoff of so many new changes around healthcare and policy in the US for 2025. Thank you to everyone that shares our content and for those that haven't, please share this with a colleague or friend that you think can benefit from this newsletter. The more you share, the more the algorithms share, and the more people can have access to this pertinent information as we all know it affects all Employer plans and members in our country. Employers today face a tough challenge: providing employees with access to advanced medical therapies or treatments while managing rising healthcare costs. The Employer Provider Council (EPC), one Council in the Hospital Quality Foundation (HQF), helps employers navigate this complex landscape. We offer guidance, facilitation, and support to build better employer plans that ensure equitable access to vital value-based, member centric care. We remain engaged by reaching out across the country or by state to hold discussions that inform, connect, and initiate employer plan innovation. Our Mission: Inform, Connect, Initiate Inform: We provide employers with the knowledge and tools to identify and address waste and inefficiencies in both financial and clinical care. Connect: We foster collaboration between employers, providers, payers, and patients to optimize care pathways and address unmet needs. As the only national group with a collaborative and integrated network of employers and providers working across all sectors of healthcare, we can drive meaningful change. Initiate: We guide employers in building plans that offer equitable access to advanced medical therapies, providing practical tools and expert support. This includes giving both payers and providers the resources they need to evaluate new treatments and make informed decisions. Join the Conversation through Upcoming Events: *Discover New Strategies: Cancer Care: Join us virtually on March 3rd at Noon EST, presented by several employer health groups. *Employer Healthcare Town Halls (Georgia & South Carolina): We're holding meetings in Georgia (March 20, 2025) and South Carolina (March 19, 2025) to hear from employers, providers, consultants, and organizational leaders about the current state of employer-sponsored healthcare. Connect with us to learn more. Visit https://epcouncil.org to learn more.? Let's work together to ensure your employees, communities, and families have access to the best possible care. #healthcare #employers #advancedmedicaltreatments #costmanagement #riskmanagement #HQF #EmployerProviderCouncil #EPC #collaboration #innovation #LinkingBusinessandHealthcare #cancercare #GeorgiaHealthcare #SouthCarolinaHealthcare

We still have 3 vertically integrated PBMs, what's next? The debate over PBM reform is set to continue into 2025. While some legislative efforts have stalled, the growing consensus across party lines indicates that the PBM business model will remain under scrutiny. Future reform efforts may revive previous proposals, potentially leading to more significant changes in the industry. - The Wall Street Journal, January 2025 Concluding PBM reform remains a critical issue in the U.S. healthcare landscape. The interplay between legislative actions, market dynamics, and industry responses will shape the future of drug pricing and accessibility. Staying informed about these developments is essential for stakeholders across the healthcare spectrum. #employers #commercialinsurance #manufacturers #onlyhealthcarepodcast.com #employeebenefits

Are you aware of upcoming virtual events or how EPC collaborations can be beneficial for your business?