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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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