Giving Thanks for Action Group Members; Playing the Rx Shell Game; Register for Dec. 18 Member Meeting…

November 24, 2015

The Weekly Buzz: Giving Thanks for Action Group Members

“Cultivate the habit of being grateful for every good thing that comes to you, and give thanks continuously. And because all things have contributed to your advancement, you should include all things in your gratitude.”
– Ralph Waldo Emerson

This brief lull before the tumult of the holiday season begins in earnest is a perfect time to acknowledge and give thanks for the dedicated Action Group members who demonstrate a selfless willingness to gather regularly in the pursuit of continuously improving the health and economic vitality of our Minnesota communities.

As I reflect on our members’ contributions and on the accomplishments of our coalition, I am humbled. It is not a small thing to step to the front lines and become part of a movement to build a better health care system. Yet our dedicated members do so time and again, whether they’re tackling the job of reducing and eliminating financial waste in the system, rewarding clinics that are improving the quality of patient care, or shaping local and national health care policy. I am deeply grateful for their service.

If you are an Action Group member and have not been to a meeting in awhile, I invite you to reengage with us. The December 18 member meeting is described below. During the January 20, 2016, member meeting, we will review our 2015 achievements and make plans for 2016. If you are not yet an Action Group member, please join us as we do together what no single organization, company or person can do alone. Member benefits are described here.

Happy Thanksgiving to all!

Carolyn Pare
President and CEO


Free on-demand webinar from Employee Benefit News: Planning, Preparing, and Calculating Your Potential Cadillac Tax Fines. Register here.

December 18 Member Meeting Agenda Set

Special guest, attorney Phil Larson, will be presenting, “The Affordable Care Act Cadillac Tax: Concerns for Employers, Employees and other Considerations.” We will also be discussing hot topics that are keeping our members up at night. Included will be how some of you are preparing for the Cadillac Tax, private exchanges, the unsustainable cost of specialty drugs – and any other concerns or challenges you are facing. If you have special areas or concerns you would like addressed, please include those in your RSVP. Click here to learn more or to RSVP.


Related and Interesting…

U.S. Doctor Group Calls for Ban on Drug Advertising to Consumers. Read more here.

The Real Cost of Prescription Drugs: Is Your PBM Playing a Shell Game?

The Action Group and its Care Delivery Learning Network (CDLN) participants have spent more than a year exploring how the excessive cost of specialty drugs is affecting Minnesota purchasers, and what can be done to manage costs that one member described as, “crushing and unsustainable.” Special Senior Advisor to the CDLN, Dr. Stephen Schondelmeyer, professor of Pharmaceutical Economics in the College of Pharmacy at the University of Minnesota, was featured in this new KARE11 story where he describes the “dirty little secret” in the prescription drug business: Pharmacy benefit management (PBM) companies that are essentially “playing a shell game” by quietly raising unreported drug costs instead of lowering them.


Join Us for the 9th Annual Employer Leadership Summit  

Save the date for The Action Group’s 9th Annual Employer Leadership Summit on April 22, 2016. This event is open to all and was sold out in 2015. We will feature national and international health care and benefits thought leaders, the Innovator’s Showcase, interactive polling, networking opportunities, sponsored booths, and lively discussions. If you or a partner organization would like to sponsor an exhibit, please contact us!


Health Care Financing Task Force Update 

With the clock winding down on the Health Care Financing Task Force, recommendations continue to take shape. A draft report is expected around December 18. Below is a summary of the ideas emerging from the various workgroups. The conversation within the Task Force continues to be fluid, so policies below are not necessarily guaranteed to be in the draft. Many of the options below are currently being modeled by outside consultants for fiscal impacts, which will add an important layer to the analysis going forward.

Barriers to Access
1) Improve and enhance community based consumer assistance resources, including expanded capacity and improved training and payment mechanisms.
2) Align benefits across the coverage continuum (especially MinnesotaCare, Medical Assistance, and the State Employee Health Plan), and/or provide access to high value benefits such as adult dental coverage and non-emergency medical transportation.
3) Require standard QHP offerings in the Marketplace to improve consumer choice and experience, including ensuring availability of no- or low-deductible plans.
4) Study recently passed telehealth laws to evaluate impact on access and cost.
5) Improve data collection and reporting.

Seamless Coverage
1) Establish a framework for evaluating MNsure following the 2016 open enrollment period

a) Assess how MNsure fits into various health coverage options, including private coverage enrollment trends.
b) Determine the percentage of those using tax credits.
c) Assess consumer experience at MNsure compared with www.Healthcare.gov.
d) Progress report on meeting benchmarks in IT development and modernization plan, including timeline and costs.

2) Private modeling is being done on various options ranging from staying the course with a Minnesota-based exchange to moving entirely away from MNsure and into the federal exchange. Many members have expressed concerns that doing so would be a mistake, as www.healthcare.gov is not set up to deal with unique situations such as the current MinnesotaCare population.

Delivery Design (largely focused on sharing of data and other structural barriers that hinder coordination)
1) In the short term: Pursue technical updates to the Minnesota Health Records Act, and improve ongoing education and technical assistance to health providers and patients about state and federal laws.
2) Long term: Conduct a study to advance recommendations on appropriate future structure of health information exchange in Minnesota that includes how, what, how much, etc.
3) Senator John Marty (DFL – Roseville) has proposed creating a Primary Care Case Management (PCCM) program. Under this setup, the Department of Human Services (DHS) would directly contract with providers for services provided to medical assistance and MinnesotaCare enrollees. Providers would be paid on a flat per-member-per-month fee, with the commissioner setting rates for specific groups including children and people with complex medical conditions. Even if the Task Force does not take this recommendation into its report, it could be revived as a piece of legislation in the 2016 session.


Thought for the Week

“There are many ways to become involved in important member and community initiatives at The Action Group. As a member-led coalition, rather than an association, it provides the perfect opportunity for like-minded employers to join forces and roll up their sleeves to improve health care and ensure the economic vitality of Minnesota communities.”

Carolyn Pare, President and CEO, Minnesota Health Action Group