In my position as the leader of a nonprofit membership organization that works to improve the quality and lower the cost of health care, I find myself in frequent conversations with employers from around the state about what they can do to wring more value out of their health care dollars. Whether it’s the owner […]
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In my position as the leader of a nonprofit membership organization that works to improve the quality and lower the cost of health care, I find myself in frequent conversations with employers from around the state about what they can do to wring more value out of their health care dollars. Whether it's the owner of a small business in Fort Kent or the CFO of a large company in Portland, everyone is worried about how they can keep their business running when health care costs are eating into larger and larger shares of profit every year.
Over the last decade we've seen family premiums shoot up nearly 50% in our state, while nationally they've risen nearly 60%. Traditional insurance plans are giving way to high deductibles and co-insurance and strapped benefit packages are putting Maine employers at a huge disadvantage when competing for top talent. As of 2014, Maine had the highest average deductible for individuals with private, employer-sponsored insurance in the country at more than $700 above the U.S. average.
The first thing I tell executives is there's hope on the horizon, things are not nearly as bleak as they seem. Here in Maine we have something going for us that a lot of other states don't, and that something is a strong spirit of collaboration.
The second thing I tell executives is that we need their help. So much of the problem with our health care system is that we're all operating in these silos that don't communicate with each other, and the result is a patchwork of fixes for our system that never quite get us where we want to go. Employers need to be at the center of the conversation. They need to be in the same room as the providers and health plans asserting themselves. The message is simple: we need greater value for our health care spend and we need to work together to make that happen.
There are some private sector employers like The Jackson Laboratory and Bath Iron Works and public sector employers like the State Employees Health Benefit program that really get this. They've become engaged in a whole range of activities to control their health care costs while improving quality and workforce health. They sit on the board and attend meetings of the Maine Health Management Coalition's “Pathways to Excellence” committees, which vet measures of provider quality and cost for public reporting, and advocate for more transparency in our system. They're actively engaged in worksite clinics, primary care, bundled payment and Accountable Care Organization arrangements with local health systems to explore alternative delivery and payment models that incentivize patient health instead of increased utilization. They're also putting robust wellness and prevention programs in place and taking advantage of our organization's health analytics.
It may not be obvious to those that aren't engaged with this work on a daily basis, but already we've begun to make some real progress. Last year Maine became the second state in the country to begin publicly reporting on the total cost of care attributed to primary care practices and we partnered with Consumer Reports on a special Maine insert on physician quality performance, and we achieved agreement on a common measure set to begin assessing the performance of Accountable Care Organization arrangements. We also achieved agreement among multiple stakeholders to cap the annual growth in per capita health expenses in ACO arrangements to the regular consumer price index rate and a common measure set to better assess ACO performance. We will issue a report this year with recommendations on how employers can move to value based insurance design strategies.
These are incremental steps on a long journey, I know, but they are significant ones. They are proof that we can move the needle forward, and that together we can build a health care system that works for everyone.
Andy Webber is president and CEO of Maine Health Management Coalition, an employer-led, multi-stakeholder collaborative. He can be reached at awebber@mehmc.org
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