Employers are in a unique position to improve the health care system and make it more affordable. Still, they need access to data and a coordinated strategy to make change happen.
The Health Transformation Alliance (HTA) is a nonprofit cooperative of leading U.S. self-insured employers that uses the companies’ aggregated health care data and collective buying power to provide higher quality health benefits for their employees at the same or lower cost. Fifty-seven member organizations from the financial services, banking, manufacturing, retail, health care, energy, agriculture, insurance, transportation, technology, oil and gas, consumer products, food and beverage, communications, and packaging industries have banded together to fix the broken health care system.
According to HTA’s CEO Robert Andrews, the financial incentives of the U.S. health care system, at times, could be better aligned with the interests of patients. “Simply put, providers are still mostly paid for volume rather than value,” he says. “This will continue to change.”
Andrews knows the U.S. health care system well. Before the HTA, he served as a member of the United States House of Representatives for nearly 24 years. President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act ... and a vital partner in its passage and implementation.”
HTA’s members believe they have a bright future in the shift to value-based health care. “Our core belief is that employers are stronger together,” Andrews says. “Even a very large company’s leverage is fairly small when it acts alone. But when we join forces, we have the leverage needed to get what is essential: data, better contract terms, and the ability to take action.”
Andrews emphasizes that HTA obtains its patient data with consent, and that data is aggregated and anonymized. “We don’t know—and don’t need to know—that Sally had a cesarean section, how much it cost and what the outcome was for her and her baby,” he explains. “We just need to know how many women on a plan had C-sections, the cost range, and the outcomes.”
However, accessing the data patients and employers need to make informed decisions about health care and benefits isn’t easy. “Insurers, PBMs, and TPAs largely control the data and they would prefer that patients and employers don’t have it,” Andrews says. “I’ve said this many times: getting data out of these organizations is like getting raw meat away from a caged lion. Even with the collective influence of our members, it took the HTA three and a half years to get data on 3 million people our members represent.”
Safety and quality data combined with aggregated data on millions of employees’ health and health care claims enable employers to negotiate and enforce payment strategies and contracts that reward providers for the best patient outcomes. Not only does this help save lives, but it also saves billions of dollars in health care costs. In the five years since HTA’s formation, the cooperative has saved employer members $1 billion in health care costs.
Access to data empowers patients to choose the best hospital or surgery center for their needs and incentivizes providers to make improvements.
“We also partner with innovative companies to offer our members pharmaceutical, medical, and consumer engagement solutions that provide the care they deserve at more affordable prices,” Andrews says. “Examples include pharmacy plans that save money, proprietary provider networks incentivized by outcomes, not volume, and technology that empowers consumers.”
The U.S. health care system may be in a crisis, but HTA’s members are motivated to make it better.
“Every one of the employers in our cooperative is taking on the health care system in America. That takes courage,” Andrews says. “For example, telling employees that you’re going to change how they get health care sounds easy. But people get used to doing things a certain way, and even if they don’t like how they access health care now, many will not like it when things change. That takes courage.
“There is also the risk of damaging relationships employers have with companies in the health care field. Health care is 20 percent of the U.S. economy. Anytime you take business away from a company in the health care field, you risk your relationship. That takes courage.”
When it comes to improving the health care system, U.S. employers are well-positioned and highly motivated to make the changes necessary for a healthier America. In the tug-of-war between fee-for-service and fee-for-value, HTA member employers are united in a push for value-based health care.