Francois de Brantes’ Post

Almost all employers believe that their network and benefits plan offer parity between medical, mental and behavioral health care. Almost all would fail the test if they tried. Not because there are worse benefits for mental and behavioral care than medical care, but rather because the networks are far from being at parity. Just try it out on your own network. Consider, for example, that most common mental and behavioral health conditions, when combined, have a prevalence rate of at least 10% in an under 65 population. That's a higher prevalence rate than cancer. It's also about the same as the frequency of pregnancies in that population. So go on your health plan's online provider directory and do a search for OBs within a specific radius. Do the same for oncology practices. Do it for hospitals that have a labor and delivery unit and for facilities that treat cancer. And then do it for behavioral health and for mental health. When I do that search, the number of providers that pop up isn't even close to the same. Is that parity? Not according to the current regs. This lack of parity, how to more fairly and accurately measure it and what to do about it will be one of the topics discussed in a couple of weeks at a special event co-hosted by Silver Hill Hospital and The Kennedy Forum, featuring Patrick J. Kennedy's new book: Profiles in Mental Health Courage. I'm honored to be on one of these panels to highlight what employers can do to provide real parity in access and coverage to their employees and talk a little about the work we're doing at XO Health Inc. to meet this important challenge. Please register for this event. https://lnkd.in/e2wqEvZE

Here's a quote from one of the authors of the recent Yale, UofW-Madison, Harvard, U of Chicago, the IRS and Treasury Department study: “We can use our analysis to estimate the effect of hospital mergers,” said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. “Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector.” The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government. Read more here. Please. We've said for years that the system is unsustainable. This study shows very clearly that we have reached that point. When rising costs lead to unemployment and suicide, in addition to simply more generalized misery, we've reached the break point, and keeping business as usual fuels this burning pyre of human hope. Unfortunately, we know that almost all carriers have been complicit in these price increases. Yes, mergers help tilt the negotiating power, but when your profitability is proportional to the misery that's created, you're not really motivated to put the fire out. And that's why the carriers happily fuel the burning pyre. And who fuels their growing pile of cash? Employers who have to lay off employees; employees who lose their jobs so that others can still receive health benefits; families that can no longer afford anything. This outcome is not inescapable. Quite the contrary. But it does require having the courage to make different choices.

There are lots of ways to control health care costs for employers and one way to keep them rising. The one way is the status quo -- keeping things the same. The alternative is to unleash the power of #pricetransparency to optimize networks -- right place, right time, right price; reduce barriers to needed care; and give plan members the support they need. That's what we're doing at XO Health Inc.

For years employers have selected TPAs and their networks based on average discount. Continuing to do that in the era in which provider prices are known is not only baffling, but opens employers up to legal jeopardy for failure to fulfill their fiduciary obligations. Prices matter a lot. The right ones that is. #pricetransparency #caa

Good primer on the rise of self-insurance, but also why it is essential for employers and their brokers or benefits consultants to use a new, less conflicted lens in assessing employer options for plan administration. The bottom line for self-insured employers, as Chris Deacon and Jeffrey Hogan repeatedly remind them, you're the fiduciary and if you ignore your fiduciary obligations, you are in legal jeopardy.

There is a handful of people whose dedication to making healthcare better has been larger than life. Suzanne Delbanco was one of them. I say was because, incredibly and sadly, she passed away early this morning after a long and grueling battle with cancer. As the founding executive director of the Leapfrog Group she transformed the way in which employers held hospitals accountable for patient safety. She never wavered in her commitment and thanks to her efforts, countless lives have been saved from patient harm. She continued her work as the founding executive director of Catalyst for Payment Reform, arming employers with tools, resources and advice on how to get better value from their health benefit plan. Her focus was always on the person, the family, the ones whose lives could be better if health plans and providers just did a better job. Those people will never know that Suzanne helped them, but she did, selflessly. To me, she was very much a sister. A sister-in-arms and a sister in spirit. She leaves a hole that will be difficult to fill. My prayers go to her family and they should know that her light will continue to shine brightly in our hearts for a very long time.

I'm honored to co-chair the Health Care Transparency and No Surprises Act Summit and to moderate a panel with two great colleagues -- Jeffrey Hogan and Chris Deacon. The Summit features an incredible array of individuals and companies that are leveraging the #transparency files and powering innovative solutions for employers to activate their employees. Hear also from Gloria Sachdev, Ge Bai, Justin Leader, and so many others that have put the interests of working Americans and their employers above all the special interests that have fed on the opacity of the system. https://lnkd.in/eiSytybv

This isn't just about inequities, it goes to the root of the importance of lifting the veil on a health plan's costs, the drivers of those costs, the distribution of those costs and the interventions needed to reduce the impact of the costs on plan members. That's why the CAA creates the additional emphasis on a plan sponsor's fiduciary obligations, the outlawing of gag clauses, anti-steerage clauses and information-blocking clauses. Any employer that continues to accept that their TPA blocks them from getting all the claims information they need to do the job they should be doing might as well put up a sign outside their corporate offices saying: Please sue me.