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Health Care Coalitions—Their Role in a Post-ACA World
Kristina D. Gaughan
Executive Director
Midwest Employee Benefit Funds Coalition, Inc.
Countryside, Illinois
Peter M. Rosene, Esq.
Shareholder
Leonard, O’Brien, Spencer,
Gale & Sayre, Ltd.
Minneapolis, Minnesota
© 2015 Leonard, O’Brien, Spencer, Gale & Sayre, Ltd., All Rights ReservedConfidential & Privileged Attorney-Client Communication
Agenda
• Role of Coalitions and the National Labor Alliance
• Initiatives from around the country
• Meeting challenges will require outstanding performance that will focus on transparency, accountability and engagement
• Role with pharma and PBMs
Foundational Definition
• Coalition Definition
– A combination or alliance, especially a temporary one between persons, factions, states, etc. (Dictionary.com)
– A union into one body or mass; fusion
– A group of people, groups, or countries who have joined together for a common purpose (Miriam-Webster)
Purpose
Many coalitions were formed as purchasing cooperatives which negotiate, on behalf of member funds, preferred pricing for health care and related benefits.
The Smarter Health Care Coalition’s mission is to enhance the patient experience-encompassing access, convenience, affordability and quality—by working together towards achieving smarter health care, with a focus on integrating benefit design innovations and consumer/patient engagement within broader delivery system reform in order to better align coverage, quality and value-based payment goals.
The NLA (National Labor Alliance of Health Care Coalitions) is a non-profit national organization of labor management health and welfare coalitions representing purchasers of health services, working together to increase value in services and benefits for participating member coalitions.
The mission of the Midwest Employee Benefit Funds Coalition (MEBFC) is to provide a forum for Taft-Hartley funds, regardless of size or geographic location, to enhance the Fund’s ability to secure quality health care at a discount, while still maintaining its individual autonomy. In addition, the Coalition will provide information sharing, monitoring the quality of care and further encourage labor-management cooperation.
Five Problems
1. The cost of being uninsuredCosts are still incurred and shifted to insured population; care is episodic and often poor care or no care is received
2. The economic cost of high health care costs$.06 to $.18 of pay being spent on health care
3. The cost of poor quality careMissed opportunities for suppression of disease
4. The problem of lack of transparency in costs and qualityPhysicians and patients blindfolded regarding both cost and quality
5. The problem of medical malpracticeImmediate reporting and resolution; safe harbors
Ezekiel J. Emanuel
ChairDepartment of Medical Ethics and Health PolicyUniversity of Pennsylvania
Using What We Own
• Our data
• Our branding
• Our customer service
• Our ability to form purchasing pools
• Networking, networking, and more networking
The Right Resources at Each Stage in the Process
Acute Illness major
Asympto-matic
Illness/Disease
HealthyAcute Illness minor
Healthy With Risk
Factors
Chronic, stable
Chronic, Cata-
strophic
“Staying Healthy” “Getting Healthy” “Living with Illness”
Maternity management
Screening exams and immunizations
Health risk assessments
Connecting individuals with health and
wellness programs
Source: Uniprise
Care outreach through predictive modeling
Health advocacy, professional guidance
Pharmacy and medical integration
Guiding patients to quality providers
Compliance support
Connecting individuals with quality care
Case management
Disease management
Compliance support
Integrated pharmacy, medical
Connecting individuals with programsto manage chronic conditions
WELLNESS DISEASE MANAGEMENTCLINICAL ADVOCACY
Data Analytics Gives You Perspective on Your Population
Managing Health and Health Care Cost
HEALTH CARE COSTTraditional• Financial• Measuring cost• Historical review of group
cost and trends• Managing cost and behavior
through– Copays/deductibles– Eligibility– Reimbursement accounts– Discounts– Networks
• Quality
HEALTHEmerging• Behavioral and clinical• Measuring individual and group
health status• Managing cost real time through
– Data– Predictive modeling
• Managing behavior through– Information/education– Leadership– Culture
• Value
Treating people when they are sick and keeping people healthy.
Health Fair 2017
• A new frontier of activity through social engagement
• Encourages players to explore their communities on foot to catch Pokemon
Thanks for Coming!
2017 Educational ProgramsHealth and Welfare
63rd Annual Employee Benefits Conference October 22-25, 2017Las Vegas, Nevadawww.ifebp.org/usannual
Certificate SeriesFebruary 27-March 4, 2017Lake Buena Vista (Orlando), Florida
July 24-29, 2017Denver, Colorado
www.ifebp.org/certificateseries
Health Care Management ConferenceMay 1-3, 2017New Orleans, Louisianawww.ifebp.org/healthcare
Certificate of Achievement in Public Plan Policy (CAPPP®)Part I and Part II, June 13-16, 2017
San Jose, CaliforniaPart II Only, October 21-22, 2017
Las Vegas, Nevadawww.ifebp.org/cappp
Related Reading
Self-Funding Health Benefit Plans | Item #7563
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