Employers
have
a
fiduciary
duty
to
ensure
they’re
providing
their
employees
with
the
best
medical
benefits
for
the
best
price.
However,
they’re
often
struggling
to
access
their
data
from
their
third-party
administrators
in
order
to
do
this.
Under
the
Consolidated
Appropriations
Act
of
2021,
employers
are
supposed
to
have
better
access
to
their
claims
data
and
can’t
enter
into
an
agreement
with
a
third-party
administrator
that
limits
their
access.
For
one
industry
expert,
this
issue
is
top
of
mind.
“[Employers]
are
having
more
and
more
accountability
placed
on
them
as
purchasers,
with
less
and
less
responsiveness
from
the
industry,”
said
Elizabeth
Mitchell,
president
and
CEO
of
the
Purchaser
Business
Group
on
Health,
in
a
recent
interview.
“So
they
will
be
changing
how
they
think
about
healthcare
procurement.
Transparency
is
table
stakes.
It
is
an
expectation.
It’s
clarified
in
the
law
that
they’re
entitled
to
the
data,
and
they
will
be
looking
to
really
just
ensure
that
they
are
contracting
with
high-value
providers,
high-quality,
low-cost
providers.”
An
example
of
this
data
struggle
is
the
Kraft
Heinz/Aetna
case,
which
went
into
arbitration
in
December.
Kraft
Heinz
sued
Aetna
for
cherry-picking
data
and
other
reasons.
Some
employees
are
also
beginning
to
sue
their
employers
for
not
meeting
their
fiduciary
responsibilities.
This
was
seen
in
the
Johnson
&
Johnson
case,
in
which
an
employee
alleged
that
the
company
overpaid
for
prescription
drugs.
Mitchell
also
shared
some
ways
PBGH
is
addressing
these
data
challenges.
The
organization
is
a
nonprofit
coalition
representing
about
40
private
employers
and
public
entities
in
the
U.S.
“We
work
really
closely
with
our
employer
members
on
how
to
be
an
effective
fiduciary.
…
So
one
of
the
things
that
we
are
doing
is
a
data
initiative
with
our
members
to
use
the
newly
available
[Consolidated
Appropriations
Act]
data
to
match
and
marry
it
with
their
claims
data
to
really
identify
who
are
top
performing
providers
in
various
regions,
and
doing
it
at
a
really
granular
level,”
she
said.
“Even
taking
the
step
of
using
their
data
is
protective
from
a
fiduciary
standpoint,
because
they
are
taking
big
steps
to
ensure
that
they
are
effectively
spending
the
money.”
She
added
that
PBGH
is
working
with
its
members
to
ensure
they
have
the
right
contracting
standards
in
place
and
have
more
accountability
from
their
partners.
Looking
ahead,
Mitchell
said
she
thinks
this
is
just
the
beginning
of
the
lawsuits
against
employers
for
not
upholding
their
fiduciary
responsibilities.
There
are
law
firms
actively
seeking
for
employees
to
sue
to
their
employers.
“There
is
every
indication
that
they
are
searching
for
employees
to
file
more
suits,”
she
said.
“So
it
is
expected.
It
is
definitely
getting
the
attention
of
a
lot
of
employer
C-suites
because
they
are
at
personal
risk,
personal
liability
due
to
the
[Consolidated
Appropriations
Act]
changes,
and
frankly,
they
have
not
been
getting
the
support
and
advice
from
their
trusted
partners
like
the
consultants
and
brokers
and
the
health
plans.
I
don’t
know
if
they
will
start
suing
any
of
them,
but
it
is
definitely
going
to
change
the
relationship.
It
has
to,
because
the
status
quo
isn’t
being
tolerated.”
She’s
also
seeing
more
interest
in
employers
implementing
direct
contracting,
in
which
employers
contract
directly
with
a
physician
or
physician
group.
This
can
provide
cost
savings,
better
outcomes
and
better
access
to
care.
In
addition,
PBGH
is
actively
working
with
Congress
on
ways
“to
enable
successful
fiduciary
roles,”
Mitchell
said.
“There
needs
to
be
much
more
clarity
on
what
we
can
and
should
expect
from
plans
and
TPAs
and
all
the
middlemen
like
PBMs
and
some
accountability
and
transparency
there,”
she
argued.
Photo:
brazzo,
Getty
Images
Kathryn
