Employer's Direct Purchasing of Healthcare
Adam Solomon, MD, MMM, FACP
Experienced Physician Executive with expertise in medicine and population health management
A few weeks ago, I was proud to participate in a lively panel discussion at the #APGFallCon23 in Washington DC around Direct-to-Employer contracting along with Linda Brady , Dan Mendelson , Bruce Muma and John Collier, MBA, MHA, FACHE , moderated by Marion Couch .
Employers have been dealing with ever-escalating healthcare premiums for years despite a lack of evidence that they are receiving increasing value for their investment. Health plans do not share any actionable data with employers and the dollars being spent don't seem to translate into a healthier, more productive workforce. This has encouraged some large employers to seek out point solutions to address areas that are perceived needs, but to me, that just contributes to an already fragmented system. What employers want is a partner that will collaborate around programs that focus on the most common ailments and issues that impact employee productivity. Most of all, this means access. Rapid responses to on-line or telephone inquiries, appointment availability at times and settings that are most convenient for the employees, assistance with navigating care, all of these reduce absenteeism.
For provider organizations, this is a potentially huge opportunity. However, these are processes and systems that can't simply be implemented on the fly or after-the-fact. It takes an organizational commitment to providing this type of experience and a data-rich infrastructure to produce insights around management of populations in order to be successful in these sorts of arrangements. It may be challenging to deliver a concierge-like service to all-comers, but it is no less challenging to provide that level of experience for just a subset of patients when it is not part of the systemic culture.
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Both the employer and the provider organization need to go into these kinds of arrangements with the expectation that it will be a long-term, collaborative partnership and bring with them a willingness to listen, adjust and compromise. Physicians aren't going to take well to a whole new set of quality metrics and employers are running out of patience for the status quo. If an employer is just looking for a health system to give discounted rates or a provider organization is hoping to "lock in" a bunch of patients, the arrangement isn't going to work.
I suspect you'll be seeing more and more of these arrangements over the next few years as inflation takes a bigger bite out of company bottom lines, making those premium increases untenable. Although the finances of health systems are looking at challenges of their own, the more innovative and patient-centered systems may start seeking out partners to support their value proposition.
Healthcare Partnership & Growth Strategist
10 个月Well said, Adam Solomon, MD, MMM, FACP. Health systems and provider groups must get comfortable meeting directly with employers to learn about what specific employee health issues they need help managing and discover ways together to become genuine healthcare partners to the local businesses and their employees.
CEO and Founder at MJM Advisory and Educational Services
11 个月A Pass Through Pharmacy Benefit Manager (PBM) refers to a type of PBM arrangement in which the PBM simply acts as an intermediary between the pharmacy and the payer (such as an insurance company or employer-sponsored health plan). In this model, the PBM doesn't directly manage or influence drug pricing, but rather facilitates transactions and administrative functions, passing along discounts and rebates negotiated with pharmaceutical manufacturers directly to the payer. In a Pass Through PBM model, transparency is often emphasized, as the PBM doesn't retain any portion of the negotiated discounts or rebates for itself. Instead, these savings are fully passed through to the payer. This model can be appealing to payers seeking greater visibility and control over their prescription drug costs. #pbm #patientcare #costplus
Medical Director at MemorialCare Medical Group
1 年This is awesome Adam Solomon, MD, MMM, FACP!
Clinical Endocrinologist, Diabetes & Endocrinology Consultants of Pennsylvania, LLC
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Healthcare Innovator - Always on the forward edge of healthcare delivery and care
1 年Employers need more full service and end to end accountability for the care and responsiveness to patient needs . Physician practices today are not designed for such outside of concierge models. However there is a working solution that embraces wrap around care and responsiveness at predictable costs that layers over a traditional fee for service network and achieves continuity, access, and reduces medical costs with high patient satisfaction.