With President Donald Trump now in office and a new Congress in place, the Purchaser Business Group on Health (PBGH) released a brief on Friday urging policy changes in two areas for employers: healthcare affordability and access to high-quality care.
PBGH is a nonprofit coalition representing 40 private employers and public organizations.
“We welcome the new Congress and Administration’s willingness to disrupt an industry that has become increasingly consolidated, unresponsive and dysfunctional,” said Elizabeth Mitchell, president and CEO of PBGH, in a statement. “The current system does not work for employers, families or most health care providers and the industry has demonstrated it will not reform itself to deliver high quality care at lower costs. Legislative action is needed to curb anticompetitive practices and enable accountability.”
In these two areas, PBGH hopes the administration and Congress will take steps to improve employer access to data, advance primary care and mental health, and implement other key actions.
Affordability
Rising healthcare costs have become a major challenge for employers. In the brief, PBGH noted that commercial premium increases in 2024 greatly exceeded general inflation. To make matters worse, the growing cost of health benefits has negatively affected wages, job growth and business investment.
PBGH argues that these costs have largely been caused by the “market power that hospitals, health systems and health plans have gained through consolidation.”
To address this issue, PBGH asked for several policy actions, including establishing transparent billing requirements and supporting pharmacy benefit manager reform. For example, PBGH wants PBMs to be mandated to report drug pricing data to employers. The organization also called on the federal government to address market consolidation among health systems and health plans.
In addition, PBGH wants employers to have complete access to their own medical claims data, including data “on the quality of health care services at the individual physician and facility level.” Employers have been struggling to access their claims data from third party administrators, making it difficult for them to fulfill their fiduciary responsibilities of getting the best medical benefits for the best price. Because of this challenge in accessing health data, some employers have sued their TPAs.
PBGH also called on the government to provide new resources for employers to participate in direct contracts with providers.
Expanding access to high-quality care
Currently, more than 30% of the $5 trillion spent on healthcare each year is for low-value care, PBGH cited in the brief. And despite primary care being one of the best ways to improve health outcomes and reduce costs, less than 10% of total health spending goes towards primary care.
PBGH urged the administration and Congress to improve primary care and provider access by allowing “robust access” to telehealth and creating new payment models for rural hospitals, birth centers and clinics.
In addition, the organization wants the government to embrace a “holistic approach to wellness,” including nutrition and social support. PBGH also wants the government to expand access to high-quality maternal and postpartum care.
“The health care market is broken. These common-sense reforms will go a long way toward establishing fair competition and greater transparency will allow the marketplace to work to better control costs and improve access to high quality care,” Mitchell declared.
Photo: alexsl, Getty Images
