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Pulse of the Purchaser: 2023 Survey (PDF)

25 presentation slides. "The Pulse of the Purchaser study gauges concerns and approaches of employers to address the workforce environment; whole person health, equity, women's health, mental health and obesity management; fiduciary perspectives; pharmaceutical drugs; high-cost claims; and potential health reforms. Among the 2023 findings: As employer concerns about healthcare affordability are skyrocketing, less than half are confident in the integrity of services and fees charged by hospitals, pharmacy benefit managers, third-party administrators, and even brokers and consultants."

Employers Concerned About Cost of Waste and Inappropriate Healthcare

"Employers perceive healthcare waste to be a problem, with majority (57%) indicating up to 25% of treatments their employees and dependents receive are wasteful. Most employers don't collect or analyze data to track waste (59%), and those that do rely on their vendors (34%).... Most employers don't report significant success in managing healthcare waste, their efforts have generally only been somewhat effective (e.g. 25% effective for medical imaging, 12% physician referrals)."

Rethinking How Employers Address High-Cost Healthcare Claims

"High-cost claims have become the single fastest-growing healthcare cost for employers in the last decade and were identified as one of the 'most significant threats to employer-sponsored healthcare' in a recent ... survey. This report offers insights and action steps to help employers mitigate the effect of high-cost claims."

Mental Healthcare Access and Quality Critical but Lacking

"While 99% [of employers] agreed that effective and timely access to in-network behavioral health providers is important; 31% expressed dissatisfaction with efforts to identify and address gaps in network access. Tele-behavioral health was important to 95% of employers and 65% were satisfied around these services. Only 34% of employers agreed that their behavioral health directories were an accurate reflection of the providers available to plan participants."

Healthcare Affordability Crowds Out Wages

"Drug prices (93%), high-cost claims (87%) and hospital costs (79%) are most significant cost drivers of employer-sponsored health benefits coverage for employees and their families. ... [A]lmost half (47%) of employers are using centers of excellence and within the next 1-3 years many employers are considering tiered networks (46%), site of care (43%), contracting and performance guarantees tied to Medicare pricing, and reference-based pricing (36%)."

Employers Using Innovative Payment Approaches Experienced Lower Healthcare Costs

"Among the strategies that are correlated to lower costs: Employers that use a value-based formulary versus a rebate-driven are nearly three times more likely to have lower spending than average. Employers that drive patients to higher quality and lower cost providers through tiered networks are twice as likely to experience lower costs. Employers that eliminate the middleman by direct contracting with providers are 50% more likely to experience lower than average costs."

Amicus Brief of Employer Organizations to Supreme Court in Challenge to Seattle Health Benefit Mandate (PDF)

"Amici and their members are gravely concerned about the consequences if state and local governments are permitted to impose play-or-pay laws, and circumvent ERISA's clear and broad preemption provision, by simply adding that, as an alternative mode of compliance employers may make a payment of the same amount directly to employees or the government." [ERISA Industry Committee (ERIC) v. City of Seattle, No. 20-35472 (9th Cir. Mar. 17, 2021; unpub.; cert. pet. filed Jan. 14, 2022)]

Opportunities for Purchasers and Physicians to Accelerate Care Delivery, Innovation and Value (PDF)

15 pages. "Recommendations for employers [include]: [1] Explore integrated behavioral health models that have a single access point for mental health services, consolidating diverse services to holistically treat patients. [2] Ease delivery of care by working directly with provider groups to eliminate the need for several vendors. [3] Review current networks to ensure that high-quality physicians are promoted and behavioral health is integrated. [4] Address waste, fraud and abuse by requiring carriers to provide an action plan to ensure accountability.[5] Request effective metrics that evaluate provider performance."

House Health Subcommittee Hearing: An Examination of How Reining in PBMs Will Drive Competition and Lower Costs for Patients

Video of hearing held Wednesday Feb. 26, 2025. Testimony of witnesses: [1] Mr. Hugh Chancy, RPh, Pharmacist and Owner, Chancy Drugs; [2] Mr. Shawn Gremminger, MPH, National Alliance of Healthcare Purchaser Coalitions; [3] Mr. Anthony Wright, Families USA; and [4] Dr. Matthew Fiedler, PhD, Center on Health Policy, Brookings Institution.

A Fresh Look at Addressing Social Needs and Social Determinants of the Workforce (PDF)

22 pages. "A key issue facing the American healthcare system is the impact of social needs, social risks, and social determinants of health (SDoH) on healthcare.... For employers, understanding these impacts within the context of a population health strategy can foster a broader approach to closing gaps in care and in access to services across employee populations. This report identifies a process model to enhance employee and community well-being."