www.nbch.org Editor’s Note: It’s the beginning of a new era for the National Business Coalition on Health, and Michael Thompson, incoming president and CEO, talks about his plans which are already underway. Michael recently convened a conference call with leaders from the health and business communities to learn about the future direction of NBCH and the future role of its National Health Leadership Council – and I was lucky enough to get an invitation. Here are some of the highlights: “I’ll just set the stage that the NBCH is an umbrella organization of coalitions across the country, represents about 51 coalitions by 7000 employers, 35 million people and the National Health Leadership Council, our multi-stake holder organization that brings together organizations that have national significance in health and healthcare. Especially as we get into a consolidation type mode, I think you really are talking about a few key players in a lot of different sectors that collectively will be able to kind of change and improve the system. Historically, the NBCH has largely focused on value based purchasing. So the new mission — as I define it — is for NBCH (which is probably not as important as the collective coalitions) to really focusing on empowering the employers and their partners to improve health, well-being and value in our companies, communities and our country. All of that really matters and is part of the reason I’ve been attracted to NBCH. My belief is that employers really are important in the context of shifting the system. I’ve been in the industry well over 30 years and with almost every change, other than Medicare, the major employers have largely driven through the system and so when you look at the supply chain, I think employers are at the top. Having said that they can’t do it alone and they can’t do it without their partners and their stakeholders. And I think that is what this organization and group is about – which is bringing people to the table that do play a major role in influencing the future directions. Frankly, many people want to influence those employers who will then influence plans who will then influence providers and pharmaceutical companies, etc. And so bringing people together to the table is very important. When I think about improving health, I think we are underperforming as an industry, whether it is employers or health plans – our health is getting worse, not better in spite of all the activity and the rhetoric around health. I do think, in fact, that community based population health efforts are going forward, and I actually think the coalitions play a very important role in facilitating and making some of that happen. I’d also say from the second tenet of well-being, it’s is an area that many people have equated to wellness even though it is not what I think about well-being. When I think about well-being, I think about helping our people, our workforces to be all they can be to thrive and be at their best — and that is an area that is underserved and ties into some key issues that are very important like mental health, social determinacy of health. I think as we take a bigger focus both on well-being within the companies as well as well-being in our communities, it is going to have a broader impact on the overall system and then finally value. I started by saying that NBCH and the coalitions have largely been focused on value based purchasing. I would argue that we haven’t done a good job at defining what value is. I know having lived on the health plan side for many, many years (I was at a health plan for 17 years) that when health plans hear value they hear cost. And yet I know today that the things that do deliver great value to people are often times our challenge because they are costly — and sometimes not even because they are costly, but because there is a cost to it. I don’t think that’s what employers want. I think they want a more thoughtful and balanced approach as to how we pay for, how we deliver and how we receive care — and I’d be glad to talk about that. One of the things I think is critical as we think about changing the system is that nobody can really do that alone, particularly when we move to the supply side of the system. It’s one thing for the employers to influence their employees and even for health plans to influence their members. But once you get into trying to influence the delivery system it is very difficult for anybody to independently influence that in a significant way. I don’t think the health plans matter; I don’t think individual employers matter; I don’t even think coalitions of employers matter. I think what really matters is getting on the same page about what the agenda is and how we are going to influence that agenda. In that regard, I think Medicare and Medicaid are very important, and employers and health plans being aligned around that will be increasingly critical. There is, of course, a lot of the system that is designed to help support and influence consumers, and how they get care and how they take care of themselves. But I think the supply chain isn’t as clean as it once was. We have a tool called eValue8‘ that we use to systematically look at all the various elements around evidence based practices, and evaluate how health plans perform against that. Yet, when you look at the functions that we are evaluating for health plans to perform, many times employers don’t even get it through their health plan. Whether you’re talking about consumer tools or population health, if you’re talking about wellness — or even networks – increasingly there are other people doing those same functions and stepping in. So I think as we think about supply chain, we are thinking we are going to have to modularize our thinking and engage more stakeholders in the mix in that conversation. Again, what makes the coalitions unique and what makes the NBCH unique is having boots on the ground across the country. I’ve had people say why would you take that job? And I think because when you look at delivery reform and improving health in our communities and in our companies, I don’t think it happens unless you localize it. And the infrastructure that already exists in our coalitions across the country is unique and won’t be built again. The key is execution, communication and collaboration, and working together to make a difference. There’s a lot of topics we can talk about on this call. From my standpoint, the issues of the day are that you can’t talk to an employer without talking about specialty drugs. You can’t talk to an employer without hearing about population, wellness, improving the health of our population and how does that play into our strategies, our communities and our companies. Private exchanges are a hot topic. Mental health, too. If there is any place in the system that is radically broken, it is mental health. Delivery payment reform, delivery and payment reform. Consumerism. Again, I think we are going to work with stakeholders to do what we can do to make it better to help use the leverage that our collective employers bring to move the system in the direction it needs to be moved. Increasingly, one of the things I’ve learned in my first 30 days here is that none of the coalitions have it all. But if you look collectively the talent, the resources, the knowledge, the programs – we are going to find a way to leverage that across the coalitions and we are going to accelerate the pace to change faster than any of these coalitions can do on their own. I look at things like the College for Value Based Purchasing, the purchaser value network, even the innovation. Some of the innovation is happening with the vendors, but a lot of the innovation is happening with the employers. I’m hearing great stories as we talk to people across the country about the great innovators. There is also the fact that so many of our coalition leaders are connected to people – like the people on this phone today — whether it is NQF, or the LeapFrog Group, or Health IT Policy or MEDPAC. It is just an opportunity for us to bring it together and have thoughtful debate, and then independently empower our stakeholders to get better to get this right.” ————————————————————————————————————————————— Q&A: Laura Carabello, Editor and Publisher, www.USDomesticMedicalTravel.com and www.MedicalTravelToday.com Since many of our readers are interested in direct contracting with employers, I posed this question: Laura Carabello (LC): I was wondering if you had any feedback on the Coalitions as far as their efforts or initiatives to contract directly with providers and hospitals that don’t include perhaps the carriers. Michael Thompson (MT): One of the things I am doing as we are getting started is I’m doing a lot of outreach with each of the 51 Coalition directors. I’ve been on it for 30 days and I’ve probably only spoken with 18 – 19 of them at this point. But you do start seeing patterns in terms of what exists where. For some of the Coalitions, they are very active in direct purchasing, collective purchasing, group purchasing and in some instances, they are quite successful in doing that. What they find is that they bring a more holistic picture of what employers are trying to drive, and they are successfully delivering that to employers on a direct basis. I would say that tends to be found more in self-contained geographies that to some degree are underserved by health plans. It gets a little harder when you are in these big metropolitan areas with very complex delivery systems all over the place that are very disjointed. It is a lot of infrastructure to build to do that. But having said this, it is more when they are building the whole thing. Again, I think there are multiple forms of transformation that are taking place. One example is if you build the whole thing and develop contracts based on this alone. Another is looking at the Center of Excellence approach where you start looking at an episode of care type structure that includes bundled payments. That approach, I think, is starting to get much more legs. Some of you may know David Lansky at the Pacific Group on Health where he has convened an initiative called the Purchaser Value Network. Simply put, it has really developed the framework for how to contract episode by episode within categories. It might start with maternity. Many in the industry believe that a high percentage of the care could be contracted that way and they received a grant. David has gotten a whole lot of grants, and he has gotten a grant to execute against this concept – not just in his area but to leverage it across the country as best as he can. Earlier this month, David asked that we convene the Coalition leaders for a call to talk through how to execute through the Purchaser Value Network. In other regions — and to his great satisfaction with the sponsorship with the National Business Coalition on Health — he had over 60 people on the call…and we only have 51 Coalitions. It was an hour call and he set a date. So will that expand? How quickly will that expand? Absolutely it will expand and Coalitions will rely on each other to execute that. We will get grants to make that happen. There’s a couple of other good examples where leaders are taking these best practices from one Coalition and applying them more globally. Larry Boress at the Midwest Business Group on Health created a whole initiative around onsite corporate clinics. He has done some joint efforts down in Tennessee around onsite clinics, bringing multiple coalitions and coalition employers together to talk about what is the current state of these clinics happening in Tennessee. Laurel Pickering in NY has done incredible work in workplace mental health. I happen to be close to that because it is an area where I am very familiar and gratified that it is now being exported. We just had a conference out in Chicago on workplace mental health leveraging the work that came out of the Northeast Business Group on Health. So this is not a DC-based initiative — this is a countrywide initiative that leverages a great deal of talented people across the country and that has access to employers in all of these communities. Some of the small Coalitions are increasingly looking for support and depending on the more sophisticated Coalitions to help them get better and help support the employers in their community. One of the initiatives we have underway is called the College for Value Based Purchasing. It is actually a one-two day seminar where we bring in Coalition Leaders – some of the more sophisticated Coalition leaders across the country to educate employers in a community where the employers can benefit from the expertise that exists collectively across the country. I think it is a mistake to see the NBCH as a small DC-based operation. The value of the Coalitions is the collective of all the Coalitions and the leadership that our little group in DC brings to this.