Yesterday, I sat down with Laurel Pickering, MPH who is the President and CEO of the Northeast Business Group on Health. This was a great follow-up to the session she moderated with PEBTF and CalPERs and allowed me to validate my list of focus areas for employers. (Note: I did not use a tape recorder and have translated our dialogue into the discussion below so while it is based on my discussions with Laurel these should not be considered specific quotes.)
The first thing we discussed was the concept of ACOs (Accountable Care Organizations) and how employers think about them (or similar concepts). She talked about the fact that most employers don’t understand the ACO framework in specific. They may have heard something about the idea of a medical home or mention of the ACO, but they are more broadly focused on the conversion to an outcomes-based future. Initially, there are some leading edge employers and coalitions that you hear talking about these concepts at conferences, but in general, employers are going to look to their payors to lead this effort and think about how to embrace these new quality and payment frameworks.
We then talked about what are the issues that keep her up at night. In general, we focused on three things:
- Reform – What is the future of healthcare reform and how will that impact employers?
- Cost – How can we control costs both direct and indirect? And, what is the role of prevention in cost management?
- Engagement – Even if we understand how to control costs, how do we engage consumers to take action? Is it through incentives, gamification, social media, mobile, or other tools?
We then talked about incentives and paying consumers (employees) for healthcare actions. She described three phases here:
- Phase I: Payment for completing and HRA (which many companies have done for several years).
- Phase II: Payment for completing specific screenings and participating in programs for which the patient is engaged (i.e., respond with the case manager calls you). (This seems to be a rapidly emerging standard with many employers.)
- Phase III: Payment tied to achievement of different outcomes (weight loss, BMI, smoking cessation, blood sugar, blood pressure). (This is a lot further off and much more complicated, but it’s something that people are beginning to look at.)
We wrapped up with two topics – new technologies and ROI. In today’s environment, everyone is looking at mobile health and telemedicine. The question of course is how to get these tools used, paid for, and demonstrating the ROI. From a technology perspective, we talked mostly about the idea of the “digitally naive” (i.e., people under 16 today) for which technology is the norm. They’ve never experienced life without mobile phones and computers and Google. As this generation becomes patients, they won’t think twice about using technology as a way to see their physician and monitor their health.
From an ROI perspective, this has become a table stake to play. Everyone requires some case study for use. But, we had a great discussion about the flexibility of calculating ROI and how companies do look beyond just the simple avoided medical costs. They look at presenteeism. They look at satisfaction. They look at overall