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.
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