Rising costs of employer-sponsored health plans now threatening both sustainability of a healthy workforce and the viability of U.S companies in a global marketplace. That means the business sector may be the most likely game changer in reforming the U.S. healthcare system. So argues Modern Healthcare Editor David Burda. He contends that the business sector is poised to dictate healthcare costs. Based on defined healthcare goals, business will decide for what and how much it will pay.

Burda, who attended the National Business Coalition on Health (NBCH) conference last fall, says there is a sense of urgency among employers to act now. Otherwise the government will step in to do it. If that happens, it will stifle innovation.

The NBHC is made up of nearly 60 employer-led coalitions which share the common goal of improving the value of employer-sponsored health plans. The organization represents 10,000 employers with 34 million employees and their families. NBHC was established to implement national purchase initiatives. It wants to help employers get more value for healthcare services. In recent years, NBCH’s role has expanded as employers strive to accelerate progress towards safe, efficient, high-quality healthcare.

Employers are in the forefront of efforts to link value to quality of care. Topping their list of desired innovations is implementation of financial incentives that are linked to health improvement programs. These programs are designed to encourage employees to quit smoking, eat right, exercise, and better manage chronic medical conditions.

The strategy appears to be working, according to NBCH’s 2008 eValue8 report, which employers use to compare the quality and efficiency of health plans. Andrew Webber, NBCH President and CEO wrote that: “Given today’s dire economic climate, purchasers need to continue to encourage health plans to adopt plan designs that will enable consumers to keep themselves healthy and not incur higher, preventable healthcare costs in the future.”

The report, which represents information from 100 HMO and PPO plans, found that many health plans have reduced barriers to essential treatments: 43% of plans waive co-pays for preventive health visits; 27% waive co-pays for diabetes drugs and equipment and 33% reduce co-pays; 20 % of plans waive co-pays for drugs and equipment and 28% reduce co-pays.

While keeping people healthy is good for society, Burda notes that healthcare providers must figure out a way to make money by keeping people healthy-rather than by treating them when they’re sick. Those providers who are reluctant to change, he suggests, can expect a return to the good old days when providers got paid to take care of someone-albeit cheaply, slowly, and only after complying with complex reporting and billing rules.

NBCH’s eValue8 report offers medical laboratories and other providers a compass for designing value-added strategies that meet the evolving goals of employers-who fund lots of healthcare in this country. Clinical laboratories are well-positioned to support changes in healthcare delivery for improved accountability, better quality and lower costs. – P. Kirk

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