Author Archives: healthaction

The Path Forward Will Fast Track Proven Mental Health Strategies–Blog

The amazing number of people who attended — and stayed engaged for the entire day with — the April 29, 2020, Employer Leadership Summit on driving improvement in mental health care and outcomes was a testament to their commitment to solving for the rapid escalation in mental health needs together.

During the Summit, we discussed the growing urgency of mobilizing employers to do all they can to improve mental health care and outcomes as COVID-19 dominates our everyday lives. Keynote speaker and founder of The Kennedy Forum, former U.S. Rep. Patrick J. Kennedy, warns of the “coming epidemic of suicide and overdose” and is calling for strong public-policy measures to counteract the threat. (See Duluth News Tribune article here).

In this confounding COVID-19 environment, we all are facing competing priorities and moving targets. Employers, already challenged by helping employees get the care they need and deserve to manage mental health and substance use challenges, now must also factor in the isolation, stress, depression, and uncertainty the pandemic has ignited. In fact, a recent Gallup online survey reveals that Americans say their mental health is suffering more than their physical or financial health due to COVID-19.

The pre-pandemic state of mental health and substance use treatment in America has been called “dire.” It’s urgent that employers must collaborate and effect change within their sphere of influence to keep a bad situation from getting worse.

The Summit’s expert speakers and panelists offered practical ways employers can help drive fundamental mental health care change and enable employees to get the care they need. Darcy Gruttadaro, J.D., director of the Center for Workplace Mental Health, provided an overview of The Path Forward for Mental Health and Substance Use, a national initiative led by experts from a group of highly influential nonprofits. The Path Forward focuses on five inter-related opportunities to drive change:

All 5 strategies are evidence-based and not yet fully implemented. For example, measurement-based care (MBC)* has been demonstrated to improve patient outcomes from 20% to 60% depending on the study, and there was a nearly 75% difference in remission rates between patients receiving MBC and those who received usual care. Yet, research showed that as little as 5% of clinicians use it every session (citations available upon request). We know what works, and we need to fast track mental health parity, Collaborative Care, and the other inter-related strategies to improve outcomes.

The COVID-19 pandemic’s intense pressure on our society and the workplace calls for heightening our work to ensure people are getting the care they need and deserve.

* Simply put, measurement-based care is using a systematic evaluation of patient symptoms to diagnose and guide treatment of patients. For physical health, it is regularly using an A1C test for patients with diabetes or blood pressure measurement for patients with hypertension. For mental health, it means regularly using validated screening tools such as the PHQ-9 for depression or the GAD-7 for anxiety.

“The pandemic will fuel the fire of our country’s mental health crisis unless organizations unite in a call to action. There’s no more time for debate and discussion. We need all hands on deck to fast track the strategies we know will work.”

~ Former U.S. Rep. Patrick J. Kennedy

Deb Krause is Vice President for Minnesota Health Action Group.



Depression Care in Minnesota: We Can’t Let Another Year Go By–Blog

MN Community Measurement (MNCM) recently released the 2019 Health Care Quality Report. We want to highlight the good news, the troubling news, and the opportunity — with a special focus on mental health and health care in Minnesota.

First, the good news.  

  • We have a level of transparency about health care quality in Minnesota that other states only aspire to have. The Quality Report is published annually, illuminating trends overall and providing valuable access to quality data at a clinic level. This transparency helps care systems, clinics and health plans understand and improve performance. It also helps individuals (patients and family members seeking care) to make informed choices and seek care from top-performing providers.
  • The most recent report highlights one very positive trend for mental health care: Adolescent mental health and/or depression screening has increased from 39.9% of patients in 2015 to 86.1% of patients in 2019. In this time of escalating concern about the mental health of our youth, this is tremendous news. We applaud the clinics that have updated their workflows to improve patient care.

Screening to identify those in need of mental health care is an important first step to getting them the care they deserve.

But the troubling news.

  • Depression remission at 6 months remains “stuck” at a particularly low level — just 8.2% in 2019, compared to 8.0% in 2016. This measures the percentage of patients diagnosed with depression by their primary care providers, who received follow-up and were reassessed at 6 months, and have improved sufficiently to be considered in remission. Mental health conditions are treatable and there are examples of providers in our communities achieving outcomes far above the average. This is what we want for all patients — that they receive good, timely care and get better. But it isn’t happening for most Minnesotans with depression.
  • For some other depression measures there was a statistically significant rate increase in the 2019 report, but it falls far short of the outcomes our community expects to achieve. For example, depression remission at 12 months was 7.5% in 2019, up from 6.9% in 2018. Despite the higher rates, the results remain troubling and there is a large opportunity for improvement.
  • Finally, there continues to be a considerable gap in performance for mental health outcome measures relative to physical health outcome measures for conditions such as diabetes, cardiovascular or asthma care.

And now, the opportunity.

Given the plateau in depression remission, we offer these words of wisdom from Henry Ford: “If you always do what you’ve always done, you’ll always get what you’ve always got.”

Here are examples of constructive action:

    • MNCM’s Board of Directors recently identified improving depression remission as one of its priorities for partnering with others to drive improvement. This will prioritize actions to enhance data reporting, support research to understand barriers, and work with the community to advance solutions.
    • The Action Group is conducting important research during 2020 to identify best practices of high-performing clinics with respect to depression remission as part of a prestigious Eugene B. Washington Community Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI). The research will identify best clinical practices and other significant factors associated with clinic performance scores on the depression remission measure. Disseminating the research findings will help providers and their patients in Minnesota and beyond.
    • The Path Forward is uniting employers, leading nonprofits, and other stakeholders in Minnesota and across the nation to execute a disciplined, private sector approach to systematically and measurably improve five established best practices of mental health and substance use care.

Measurement is the starting place. Improvement is necessary. Results are the goal.

All stakeholders have a role to play — health plans, care systems and clinics, providers, nonprofits, coalitions, and employers. Let’s hold ourselves accountable for aligning efforts to drive meaningful improvement in depression remission. We can’t let another year go by.

“Without continual growth and progress, such words as improvement, achievement and success have no meaning. “
​–​ Benjamin Franklin

Liz and Deb

Deb Krause is Vice President for Minnesota Health Action Group; Liz Cinqueonce is Chief Operating Officer for MN Community Measurement.






Blog: March is Colorectal Cancer Awareness Month! Employers can Pledge to Increase Colorectal Cancer Screenings

Since 2000, March has been designated “Colorectal Cancer Awareness Month.” To drive a measurable increase in screenings and reduce deaths due to colorectal cancer, employers can participate in the 80% Pledge sponsored by the American Cancer Society and the National Colorectal Cancer Roundtable. It’s a national effort to raise colorectal cancer screening rates to at least 80%.

Colorectal Cancer is preventable and treatable

Here are some facts:

  • Colorectal cancer is the third most common cancer diagnosis and the second leading cause of cancer death in Minnesota for men and women, yet it can be prevented or detected at an early stage when it is most treatable.
  • Colorectal cancer begins with a growth (a polyp) that is not yet cancer. Testing such as colonoscopy can find polyps before they become cancer. Most people who have polyps removed never get colon cancer.
  • There are several screening options available including simple, at-home stool tests for those at low risk.
  • Screenings cost much less than treatment, and early stage treatment costs less than late stage treatment. These costs are for medical care only and do not quantify the emotional impact of cancer on individuals and their families or lost workplace productivity.

FACT: In Minnesota, the statewide average for colorectal cancer screenings is 71%, which ranks #9 nationally.

Employers can break down barriers to screenings

It begins with understanding: How many employees/dependents are 50 or older? How many are up to date on screenings? Some employers are surprised to learn screening falls well short of the 80% goal.

Armed with this information, here are ways employers can break down the barriers to screenings:

  • Reassure employees that colorectal cancer screening is of utmost importance and is a fully covered preventive care benefit.
  • Some employees may avoid colonoscopy because they’ve heard the prep is unpleasant. Advances in simple, non-invasive home testing for those at low risk make it a great option for many.
  • Having easy access to testing can also help increase screening rates. Employers can provide the home stool tests in combination with a flu vaccine campaign or as part of wellness fairs. Employers with onsite clinics can leverage this resource to address access issues.
  • Employees may forgo a colonoscopy because they need to use vacation or PTO. Some progressive employers are beginning to offer a “day off for health,” allowing paid time away from work for necessary exams and screenings.

Colorectal cancer is one of the few cancers preventable through screening, and screening can also find the disease early when it is most treatable. Nationally, colorectal cancer rates have dropped 30% over the past decade, largely due to an increase in screenings. Employers can help spread the word about the importance and ease of screening options.

Recommended reading and learning opportunities:

Bringing Employee Health Plan Benefits into 20/20 Focus! – Blog by Jon Schloemer, Vice President of HR Shared Services, Fleet Farm, Action Group Board Member

With the New Year comes a new focus on gaining insight into Minnesota health plan benefit benchmarks and employer innovations to inform 2021 open enrollment planning.

The Minnesota Health Action Group Annual Employer Benefits Survey — which is confidential, unbiased, free and open to all employers with employees in Minnesota — is an outstanding resource I rely on every year to add depth to benefits decision making at Fleet Farm.

In my 2018 blog, I highlighted three things that I especially appreciate about the Survey: It is by employers, for employers; it provides valuable insights to support strategic and tactical decisions; and it is timely. Those things are still of high value.

In my 2019 blog, my message was simple: “I’m in,” meaning I never miss an opportunity to complete the Survey, and I gain even more knowledge through collaborating with other employers about the Survey results.

This year, the 10th year of the Annual Employer Benefits Survey, means in 2020 we grow even closer to gaining 20/20 vision about health plan benefits benchmarks and creative solutions that are working for Minnesota employers. While there are other benefit surveys available, I find The Action Group’s Survey particularly valuable.

Amid the many competing priorities and ever-changing vendor landscape, this Survey is a trusted resource that helps me understand what other leading employers are doing — and considering — to deliver high-value, cost-effective health care benefits to their employees.

The 2019 Survey revealed that:

    • Costs in Minnesota are high and far outpace national averages.
    • Employers are ramping up efforts to improve workplace mental health.
    • Employees increasingly value cultures that foster well-being.
    • While many challenges and actions apply regardless of size or type of employer, there is some variation, with larger employers and corporate employers more likely to embrace innovation and change.
    • There is a plethora of design tactics and vendor solutions being used by employers with varying degrees of effectiveness.
    • Efforts to dramatically reduce health care waste are gaining momentum.
    • Employers are ready to make significant health care benefit changes; employees are not on board.

These findings have led me to have lively conversations with my peers about how best to take action to make health care more affordable and accessible for our company and for our employees in ways that complement recruiting and retention activities at a time when competition for talent is at an all-time high.

I am grateful to every employer who takes the time to complete the Survey. The idea that there is strength in numbers is not new; the more of us who participate, the stronger the results. This enables us to accelerate health care improvements in ways that ultimately serve every Minnesotan.

Will you join me in taking the 2020 Survey to gain 20/20 insight? I hope you will say, “YES!” You will find details about this year’s Survey here.
  • SURVEY DATES: January 27-February 28, 2020
  • SURVEY RESULTS WEBINAR: April 8, 2020 (9 a.m.-11 a.m.)
  • View 2019 Survey Summaries here

Jon Schloemer is Vice President of Shared Services at Fleet Farm and serves on the Minnesota Health Action Group Board of Directors.



Inquiring Minds Might Want to Know – Blog by Deb Krause, Action Group Vice President

“While it’s no surprise that we have a long way to go before we achieve parity in mental health care, the Minnesota version of the eValue8 Deep Dive is an important step to get every stakeholder on a shared path that will generate accelerated action toward long overdue change.”

Nance Lee Mosquera, Benefits Manager, City of Saint Paul

The Action Group just published the results of the “eValue8™ Mental Health Deep Dive for Minnesota Health Plans.” You can read the news release, review the executive summary, and view the October 2, 2019, results webinar presentation to learn more. It’s important to know that this report has been in the works a long time, and was thoughtfully and collaboratively produced, with a strategic intent. This blog shares a “behind the scenes perspective” on the report that I thought inquiring minds might want to know.


First, The Action Group (and our member employers) are very GRATEFUL to the three participating health plans — Blue Cross Blue Shield of Minnesota, HealthPartners, and Medica. They stepped up, completed the request for information to the best of their ability, and provided a level of transparency on mental health care in Minnesota that we have never had. To be fair, they wanted to talk through questions and concerns, and they pushed back on the timing. We did everything we could to make it easy for them to participate. The Action Group absorbed the cost of the researcher, adjusted the timeline to accommodate their request, promised that results would be “blinded” (Plan A, B and C — not identified by name), and assured them that we would not conduct this analysis again for at least two years (to respect their time and give them an opportunity to implement changes).


Second, the request for information included questions that are highly ASPIRATIONAL. The National Alliance of Healthcare Purchaser Coalitions and Michael Thompson, president & CEO, deserve significant credit for both the vision and execution of the Deep Dive. The national report released in 2018 paved the way for the Minnesota report published in 2019. To develop the questions used in the Deep Dive, the National Alliance convened a panel with industry experts and funders, leading coalitions across the country, and passionate employers*. The questions are insightful and comprehensive, yet focused and relevant. The aspirational questions convey forward-thinking purchaser expectations for high-value mental health care. When I discussed this recently with a consultant from a major consulting firm, I learned that the firm conducts RFPs asking significantly more questions that are primarily tactical. The consultant shared, “We wouldn’t have even known to ask these questions.” Because of the aspirational nature of the questions, we didn’t expect to find any “A students” among the health plans. Indeed, that proved to be true.


Finally, the results of the analysis are ACTIONABLE. Each of the participating health plans received a Summary and Recommendations report, identifying gaps and opportunities for improvement. I personally participated in meetings with each of the plans, and all of them received the recommendations with a level of interest that is both impressive and encouraging. The results are also actionable by others:

    • Employers can use the questions to guide enhancements in plan design and inquiries regarding their health plan’s services and results (ongoing and as part of future RFPs).
    • Care systems (hospitals and providers) can use the questions to guide their product development and service enhancements to address purchaser expectations.
    • Other stakeholders and groups (including the multi-stakeholder Mental Health Guiding Coalition convened by The Action Group) can use the results to inform marketwide collaborations to drive improved mental health care and outcomes.

This is ambitious and difficult work, and it won’t happen overnight. It also won’t happen unless we get started. The Deep Dive gives us a baseline on where we stand and a clear picture of the changes needed.

On a personal level, I found my role in executing the Deep Dive to be a wonderful and challenging learning experience, as well as a unique opportunity to play a meaningful role in driving change and transformation. This is powerful information, and I am hopeful that it will be used to its full potential.

If you have other questions on the “behind the scenes” perspective, please feel free to reach out to me.

“We heard from many of the plans that we were the first to be asking these types of questions and taking this level of a deeper dive into mental health care and services. Clearly, these are questions that must be asked.”

Michael Thompson
President and CEO, National Alliance of Healthcare Purchaser Coalitions

*Best Buy, McMurry Cos, OPM, Prudential, FedEx


Deb Krause is Vice President of the Minnesota Health Action Group.


Reflections on an Extraordinary and Enriching Journey: Carolyn Pare’s Farewell Blog

We gathered questions from Carolyn’s network to share her thoughts on her tenure with The Action Group, plans for the future, and hopes for her successor

What was your primary aspiration when you took over as president and CEO of The Action Group 20 years ago?

Before I became a Board member and eventually Board chair, I’d spent a couple of years attending what was then Buyers Health Care Action Group (BHCAG) meetings when the whole concept of group health was new to me. Although I sat in the outer-ring chairs, waiting to be called to the “Big Kids’ Table,” I was listening and learning — and incredibly impressed by the passion of high-profile HR and benefits thought leaders who were willing to take risks to improve the health care system and address the stunning and unchecked variation in health care quality and cost. My fresh perspective back then allowed me to fully appreciate that existing programs were not rational, and that recommended Action Group course corrections were directionally smart. The radically different, employer-managed, consumer-driven model embodied the principles of managed competition. I couldn’t think of anything more fun and challenging than to become firmly committed to transforming health care through the work of The Action Group.

How did your aspiration evolve over the years?

I’ve seen an incredible amount of change. We’ve gone from being an organization that was basically offering an employee health benefit program called Choice Plus to one that tried to inculcate all that it thought was right into the program. We put a lot of effort into identifying like-minded vendors and service providers to help employers understand the value of collaborating across the health care supply chain to better manage costs and improve care. The employer voice is powerful, and when we make our shared expectations known, vendors hold themselves to a higher standard and understand that incentives and rewards will be geared toward reform-oriented activities. We were learning as we were building Choice Plus, quietly infusing important concepts into the way we did business.

Then came the National Data Cooperative which helped us understand cost-saving and quality improvement goals. Minnesota Bridges to Excellence was about quality improvement that was agnostic to plan or network. We had deep and abiding commitments from a diverse set of stakeholders to work together to improve care on behalf of the people of Minnesota. We’ve also used — and are using again to improve mental health care in Minnesota — the eValue8™ tool that enables us to educate employers about identifying and buying quality. Learning networks on a variety of high-cost, high-variability conditions revealed further quality and cost chasms and led to real solutions that are now in play. Today, multi-stakeholder groups come together through The Action Group to fix a health care system that was never built.

That’s a very long answer to say I started out thinking the great people around the “Big Kids’ Table” would solve for health care chaos. Now I say, involve everybody! It can make life better for all. It was once about employer members only, now we know we have to take off our “corporate hats” and create higher value for all Minnesotans. The Action Group now focuses on a leadership, not a transactional, position. What I’ve learned in my journey is that we must take our work out broadly so Minnesotans are more vibrant, well, healthy. We create thriving organizations and communities when we are all able to access needed health care and services.

What I’ve learned in my journey is that we must take
our work out broadly so Minnesotans are more vibrant, well, healthy.

What is the most gratifying initiative you worked on during your time with The Action Group?

Of course, being part of the Choice Plus chapter was very gratifying. It was breakthrough thinking for the largest Minnesota employers to join forces and develop a direct-contracting model to reward health providers that were efficient, made good business decisions, and kept costs in check. We forget how revolutionary that was and how it has informed sustainable, positive change throughout the health care system in Minnesota and beyond.

Minnesota Bridges to Excellence holds a very special place in my heart, though. It was a start-to-finish program and it was particularly rewarding to nurture it every step of the way. I’m really, really proud of how the entire community came together to change care. We helped amplify the voice of purchasers, sending a clear message to the marketplace about expectations for high achievement and continuous improvement. Resulting infrastructure changes are impressive. We set goals for the entire state in improving care in diabetes, vascular conditions, and depression, then set about to accomplish them.

We have always had a knack for creating a safe place for candid, open, honest, real conversations — even among sworn competitors. There’s a bit of magic in convening competitors and opening conversations in true collaboration with shared goals in mind.

What are the top books, podcasts, people or resources that have informed your leadership in recent years?

There’s no single person, place or thing that informed my direction and approach. A lot of what I’ve assimilated has been through learning a little something from everyone I meet. Admiring adversaries, picking up points about how I can be more effective at my job…basically, going into every situation with my eyes and ears open. Most important, I’ve learned to adopt practices I admire and to be completely authentic.

I am who I am and, while speaking my mind honestly hasn’t always worked to my best advantage, I’ve been true to my beliefs and my expectations that people do what serves the greatest good.

Can you share your favorite “it wasn’t funny at the time…” story about a challenging situation that you now laugh about?

Leading a small organization with small resources — and one that was expected to make transformational health care changes statewide — was sometimes very lonely and a bit terrifying. Small “human moments” had a way of keeping things in perspective. I still cringe a bit when I recall being in a very serious meeting with some high-powered executives, not realizing my teen-age daughter thought it would be funny to turn up the volume on my phone and change my ringtone to “PICK UP THE GODDAMN PHONE!” Or when I thought I was rocking a custom maternity outfit, waltzing out of the ladies room, only to be told by a compassionate soul that my skirt was tucked into my ample yellow maternity panties. Things always seem to turn out O.K. It’s important to relax into the journey.

As a health care insider, what do you believe are the top three changes that need to be made to improve the U.S. health care system?

  1. Change the way we pay for services. The U.S. health care system is completely irrational and it doesn’t work for consumers. Maybe now that the cost of employer-sponsored health care coverage tops $20,000, outrage will reach a tipping point and action will accelerate.
  2. Take action to force down health care prices. Aligning incentives across the entire supply chain is essential so everyone is working toward the same end point. In the Choice Plus days, we paid providers for delivering evidence-based care at the right cost and encouraged employees to seek care based on how the provider was performing.
  3. Make transparency the price of admission. People must know what they are paying for and why it is that price, which forces quality expectations. Consumers have largely abdicated cost and quality to health care industry practices that are not in their best interest. Patient protections and patient-centered care are needed for consumers who are being hurt the most by unchecked costs and a dearth of quality information. 

How can your successor and members help advance these changes within the sphere of The Action Group’s influence?

Continue offering proof that Action Group members are much stronger together than they are alone. Those employers who are doing things “better” should be expected to play leadership roles within the coalition. We share a moral responsibility to make the system better. That is not a small thing.

“We share a moral responsibility to make the system better.
That is not a small thing.”

What is the greatest piece of advice you have for your successor?

The first thing that comes to mind is to celebrate small victories; don’t get discouraged by the typical glacial pace of change in health care. While disruptive change is gratifying, incremental change that is substantive and quiet ultimately leads to sustainable improvements. Steady tenacity keeps things moving forward. It’s also important to remember that this work is about helping people and doing good for others, otherwise, what’s the point?

What advice would you give a young person entering the wild world of employer-sponsored health care benefits?

See above! Be patient. Celebrate incremental victories. Remember, it’s about people!

Do you plan to stay involved in driving change in the health care marketplace? If so, any concrete plans?

I will remain on the NQF Board and looking for opportunities to stay involved with the California Health Benefits Review Program. My mind is always open to juicy opportunities that arise. In recent years, I’ve been drawn to environmental and women’s rights issues.

What would you like people to say about your Action Group legacy?

Since the announcement of my retirement, I’ve been receiving lovely messages from the many people I’ve had the privilege of working with throughout my career. When people say I made a difference or The Action Group made a difference in their lives or in the lives of others, it means the world to me. “You were fun to hang out with!” is another favorite!

“When people say I’ve made a difference in their lives or in the
lives of others, it means the world to me.”

Please share your favorite inspiring quote and how it has relevance in your life.

Dr. Suess said, “Don’t cry because it’s over, smile because it happened.” We get too caught up in what was instead of celebrating the experience for what it was. Each chapter of each life brings unique life lessons and we have to trust our instincts when it’s time to turn the page.

What will you miss most about serving as The Action Group’s leader?

I’ve had the luxury of meeting and working with so many different kinds of people with exceptional talents and expertise. I’ll miss the intellectual stimulation of frequent interactions that were filled with diversity of thought and lively discussion. It was a rare day when I wasn’t learning something awesome. Many people along the way have become fast friends, so I take comfort in knowing those relationships will continue.

What will you not miss at all?

Begging people to speak for free. Buying eggs and fruit at Target for early morning meetings. Having to be the A/V girl at meetings. This has not been a glamorous job by any means. I could be meeting with an internationally renowned professor or the CEO of a Fortune 50 company in the morning and taking out the garbage in the evening.

Which books are on your nightstand, just waiting for October 1 (retirement date) to roll around?

  • Turtles all the way down, by John Green
  • Isaac’s Storm: A Man, a Time, and the Deadliest Hurricane in History, by Erik Larson
  • A Gentleman in Moscow, by Amor Towles
  • And one I reach for often, The Dalai Lama’s Little Book of Wisdom. It’s been called the essential guide to living and dying well.

What are you most looking forward to in retirement?

 Not having any “have tos!”

“Leadership is about making others better as a result of your presence and making sure that impact lasts in your absence.”

Sheryl Sandberg, COO, Facebook

What Should I Do Now? Blog by Deb Krause, Action Group Vice President

“Given the unsettling fact that death rates are increasing in areas like suicide and substance use at a time when more money is being spent than ever before on behavioral health, employers can and must demand data, enabling them to create a detailed, specific plan to address deficiencies.”

 Henry Harbin, M.D., Psychiatrist, Health Care Consultant, Special Advisor to The Action Group’s Mental Health Guiding Coalition

Each year, May is Mental Health Awareness Month. This year, I authored a three-part blog series encouraging employers to have meaningful conversations with their health plan to share the importance of mental health care and outcomes to the employer, understand what the health plan is doing to ensure mental health parity, access to care, and reimbursement for the organization’s employees, and collaborate to establish a plan, together, to set clear goals, measure progress, and have regular conversations to ensure that for the organization’s employees:

Everyone who needs care can seek it, without discrimination.

Individuals have access to high-quality, affordable, integrated, and measurement-based care, when and where they need it.

Providers are paid fairly, and payments include incentives and reward providers for high-value care.

So that, patients with mental health conditions get better.

I also shared, and encouraged employers to use, the Model Data Request Form (MDRF) to gather valuable and actionable data based on their employees’ experience when seeking to access mental health/substance use disorder treatment. Recently, a Minnesota employer who is part of our Mental Health Guiding Coalition asked for additional help and suggested that I write a follow-up blog.

“We sent the MDRF to our health plan. The response showed serious need for improvement. When I asked for an improvement plan, what I received was woefully inadequate—lacking meaningful action steps, measures of progress, and specific timing. What should I do now?” ~ Action Group Employer

Receiving an inadequate improvement plan could signal that the health plan didn’t take the request seriously, or perhaps they failed to involve the right people in preparing the plan. Maybe, they didn’t invest enough time in creating a thoughtful plan, or maybe they don’t know what needs to be done. Whatever the reason, it is important for employers to be vigilant. Here is a template plan for employers to use with their health plan to document, discuss, implement actions, and monitor progress in closing the gaps in mental health care identified in their data.

As with any performance improvement plan, it is intended to be: Specific, Measurable, Attainable, Relevant and Timely. It aligns with the eValue8™ Mental Health Deep Dive for focus and consistency, and it is intended to be a living document. Quite simply: Make a plan, then work the plan.

This is not a theoretical conversation. We are talking about patients who need mental health care, and it is essential that employers and their health plans work together to provide access to high-value care. It’s a moral imperative, and it is also the law.


Deb Krause is Vice President of the Minnesota Health Action Group.



What’s Wrong with this Picture? Health Care System Waste and How Employers Can Take Action–By: Carolyn Pare, Action Group President and CEO



A close friend and colleague recently shared some troubling news. Despite having a respectable income and health insurance, she has been off her blood pressure and cholesterol medications for several months because she can’t afford the hundreds of dollars for the office/lab visit required to renew her prescriptions.


The prescriptions themselves are $18 and $22, but her insurance is $1,200/month — for a $13,000 deductible policy — making “routine care” inaccessible. And she’s far from alone. This June 2019 KFF report is a wake-up call. Costs have become prohibitive to Americans seeking or adhering to health or dental care. Fear about the cost of needed care affects the uninsured and insured alike. HALF of U.S. adults say they or a family member delayed or skipped care because of costs.

And this turmoil is occurring while the U.S. health care system wastes $765 billion annually — about a quarter of all the money that is spent. From low- or no-value (and even harmful) care, to fraud and abuse, to administrative complexity, to lack of transparency, to poor care coordination, to outrageous prices, to unconscionable executive salaries, to a lack of accountability, to pervasive health illiteracy.


What’s wrong with this picture? And how can Action Group members and other employers present a united front to bring about change? Let’s bring some manageable action steps into focus.

  • Take advantage of opportunities to network and solve problems with your peers through Minnesota Health Action Group member meetings, Learning Networks, Guiding Coalitions, Community Dialogues, and other events and activities. Use Action Group resources such as the Specialty Drug Employer Playbook and Working Well in Minnesota: Insights and Actions to Help Minnesota Employers Advance Mental Health in the Workplace. Check out our website for the latest news and information.
  • Collaborate with and influence health plans to address health care fraud, waste and abuse. Set expectations for regular reporting.
  • Put performance guarantees in place that include measures for overuse and underuse of health care services into contracts of your health plan’s provider networks.
  • Review and assess your provider network. Do they practice shared decision making with patients? Do they closely follow evidence-based treatment guidelines? What initiatives are in place to reduce waste?
  • Use the passage of the 2019 “Minnesota Pharmacy Benefit Manager Licensure and Regulation Act” to shake up conversations with your PBMs, holding them accountable for fulfilling their intended role of keeping down drug prices.
  • Set forth a strategy to transition as quickly as possible away from traditional fee-for-service to value-based arrangements such as bundled payments, pay-for-performance, and accountable care organizations (ACOs) that put the health system partially or fully at risk for health care costs.
  • Be aware of how organizations and institutions are spending health care dollars on increased profits and margins rather than on direct improvements in access, quality and affordability of care. Does it seem reasonable that hospital revenues are higher than ever and CEOs of 70 of the largest U.S. health care companies cumulatively earned $9.8 billion in the seven years since the Affordable Care Action was passed? While 45% of uninsured adults say the cost of coverage is unaffordable and medical bills are the number one driver of personal bankruptcy? Work with policymakers to call for change that puts people above profits.
  • Involve employees in protecting themselves from outrageous medical bills; educate them about the importance of shared decision making and Choosing Wisely®, an initiative of the ABIM Foundation that advances a national dialogue on avoiding unnecessary medical tests, treatments and procedures by providing recommendations to patients on overuse of health care services.
  • Improve the accessibility, quality and safety of health care; reduce costs; and improve the health and quality of life for your employees by creating your own action plan to improve health literacy, using the National Action Plan as a guide.


It’s clear that combating waste requires employers, employees, health plans, care systems, patients, providers, consultants, vendors and others to work together. And while there is so much wrong with the U.S. health care picture, employers can help make it right by using their unique sphere of influence to drive crucial change at their organizations, in their communities, across Minnesota, and throughout the country.

Carolyn Pare is the President and Chief Executive Officer of The Minnesota Health Action Group

Can We Talk?–Blog by Deb Krause, Action Group Vice President (Part 3 of 3)

“Poor mental health in the construction industry has been called a ‘silent epidemic,’ with work-related stress, depression and anxiety having overtaken musculoskeletal disorders as the most reported workplace health issue in the sector. By collaborating with members of The Action Group’s Mental Health Guiding Coalition, our voice in the marketplace is amplified so we can accelerate needed changes on mental health affordability, accountability and access to ensure our team members can get the care they need.”

Jean McGrory, Director, Total Rewards, Mortenson

May is Mental Health Awareness Month, and I believe there’s a very real and urgent need for employers and their health plan(s) to talk. In this edition of my blog, I’m turning the focus to enabling these important conversations. (See parts one and two.)

As a coalition of employer purchasers, The Action Group, in collaboration with the National Alliance of Health Care Purchaser Coalitions, is conducting the eValue8 Mental Health Deep Dive for Minnesota Health Plans.

This is a rigorous “request for information” process, backed by employers and mental health experts nationally. It asks detailed and important questions about health plan capabilities as it relates to providing the high-quality, affordable, integrated, and measurement-based mental health care that employers expect and employees deserve. The Action Group is very grateful to Blue Cross Blue Shield of Minnesota, HealthPartners, and Medica for participating in this meaningful initiative. It will improve understanding and serve as a foundation for quality improvement at a statewide level, and we will be sharing results with employers and all Minnesotans later this year.

But, employers — NOW, during Mental Health Awareness month, I encourage you to take time to have a conversation with your health plan. There’s a problem, and you need more information to be vigilant. ASK: Do my employees have access to the mental health care they need? Can you show me the data? What are you doing, specifically, to improve mental health parity, access to care, and reimbursement for my employees? What can we be doing together to improve mental health outcomes for my employees? What is our plan, together, to set clear goals, measure progress, and have regular conversations to ensure that, for my employees:

Everyone who needs care can seek it, without discrimination.

Individuals have access to high-quality, affordable, integrated, and measurement-based care, when and where they need it.

Providers are paid fairly, and payments include incentives and reward providers for high-value care.

So that patients with mental health conditions get better.

Excellent tools are available to support the conversation (see resources list below), and employers who need help in starting the conversation can reach out to me directly. It’s time to talk!

Helpful Resources for Employers







Can We Talk?–Blog by Deb Krause, Action Group Vice President (Part 2 of 3)

With all of the recent attention to mental health globally and nationally, this is a ‘moment in time.’ Employers are uniquely positioned to positively impact the market by articulating their expectations for high-value care and asking questions that hold their vendors accountable to high standards and positive outcomes.”

Darcy Gruttadaro, Director of the American Psychiatric Association Foundation’s Center for Workplace Mental Health

May is Mental Health Awareness Month, and last week, I kicked it off by suggesting that it’s time to talk. We have strong evidence that — despite the importance and relevance of mental health — employees are not always getting the mental health care they need to get better.

Second, we have evidence that employers (as plan sponsors and fiduciaries) do not have the information they need to be vigilant.

Here are a few examples from our 2019 Annual Employer Benefits Survey:

  1. Have you conducted an independent compliance assessment with mental health parity? Only 13% of employers have. The rest either have not or don’t know.
  2. Have you taken action to equalize reimbursement rates for mental health/substance use disorder (MH/SUD) specialist and medical surgical providers for similar services? Nearly 70% of employers either don’t know or are not considering.
  3. Has your health plan/vendor turned on all four collaborative care codes and promoted them with no employee copay? Fully 95% don’t know or aren’t considering this, despite the fact that collaborative care is a model of care delivery proven to deliver results in over 80 randomized clinical trials.

There are many other examples and data points related where “I don’t know” is the most common response regarding actions to improve mental health parity, access to care, and reimbursement. So, YES, something is wrong, and it is having a real and damaging impact on individuals, families and the workplace.

Mental health is the leading cause of disability worldwide, and Survey respondents tell us that low emotional well-being and stress are impacting the workforce in suboptimal performance at work/presenteeism (70%), more absenteeism (68%), and conflict at work (50%).

Watch for part 3 of my blog with information about what The Action Group is doing to enable meaningful conversations between employers and their health plan(s) about mental health care.

Helpful Resources for Employers