Employers have tried it all to stem their ever-ballooning healthcare costs – high-deductible plans, wellness programs, centers for excellence where employees can get certain common but expensive procedures done.
And none of these strategies have worked to lower overall costs. Employers currently have to shoulder the $7,500 per employee in annual healthcare coverage costs, said Mark McClellan, founding director of the Robert J. Margolis Professor of Business, Medicine, and Policy, and founding Director of the Duke-Margolis Center for Health Policy, Duke University, at a panel discussion at the annual virtual J.P. Morgan Healthcare Conference on Tuesday.
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In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
Now Morgan Health, the company created by JPMorgan Chase to reinvent employer-sponsored after Haven faltered, is trying a new approach. One based on accountable care and focusing on advanced primary care.
“We have today about 150 million Americans who get their care through their employer. That’s more than Medicare and Medicaid combined but most of it is largely unmanaged,” said Dan Mendelson, Morgan Health’s CEO, in the same panel discussion at JPM. “We pay for volume. We pay when someone goes to see a physician or goes into the hospital, but we don’t have a lot accountability for population health outcomes. We aren’t really paying for quality and holding the system accountable for improvements in quality. This is the time that employers have an opportunity to step up and really engage the healthcare system to expect more and to bring some of these accountability models So that really is our first focus at Morgan Health.”
To that end, starting this month, JPMorgan Chase’s California employees — numbering around 8,000 —will be able to access care through Kaiser Permanente. Kaiser Permanente, with its integrated model of providing care and paying for it, is widely considered to be effective at delivering quality care while also keeping costs low.
“Accountable care is in part about being good financial stewards for the resources that we have,” said Andrew Bindman, EVP and chief medical officer, Kaiser Permanente, on the panel discussion about employer-sponsored care.
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A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The attraction to Kaiser is not just based on its ability to keep costs under control. Their integrated structure allows data to be gathered not just from claims but from the EHR thus providing a more complete picture of patients. For Morgan Health, which is making reducing health disparities a priority, access to this data is key.
A statement forwarded by a Morgan Health’s chief spokeswoman read: It is our shared goal that JPMC and KP intend to jointly implement performance guarantees, linked to health equity, on a subset of quality measures for JPMC members in the next calendar year.
Bindman added that another component of accountable care is “really committing to the highest quality for our populations…. We are [also] transparent about our performance and share our performance back with our customers so that they can see what is the quality of care being provided to their members – and they can see that data stratified by race, ethnicity and other social factors ….”
Better data is what Mendelson believes to be a key differentiator in the decades long effort to overhaul the nation’s healthcare system.
“I think one of the things that makes this moment different is that we do have better data and we can have better data, and that’s one of the reasons I am excited to work with Kaiser on this because there’s really no system that has a better handle on the data than Kaiser,” he said.
While the partnership with Kaiser has kicked off in California, a pilot that Mendelson previously indicated would launch January 1, has not gotten off the ground.
Anne Pace, the head of communications at Morgan Health, explained the delay by noting that the company “was working to get it right” and that most employees were still working from home, given Covid. Onsite clinics are part of that pilot and so those would not be used unless employees are there. She expects the pilot to launch “in a few months.”
Through the pilot, Morgan Health will be testing its advanced primary care model where patients will have the ability to get care digitally while also having some flexibility to “choose specialists outside of an immediate system,” Mendelson said.
In Ohio, Morgan Health is working with Central Ohio Primary Care, which bills itself as the nation’s largest physician-owned primary care practice. Employees who have a different primary care provider do not have to switch to a doctor in this network, Mendelson clarified, noting that about half of JPMorgan Chase’s Columbus employees are already receiving care from Central Ohio Primary Care.
The pilot will also test the model that Vera Whole Health has developed, in which Morgan Health has invested $50 million. Seattle-based Vera Whole Health currently operates a network of primary care centers across 10 states and has an existing relationship with Central Ohio Primary Care. The company recently purchased care navigation company Castlight Health for $370 million as guiding employees to the highest-quality but lower-cost providers for their healthcare needs becomes valuable to employers as another tool to contain costs.
None of this is easy of course and requires a system redesign. Mendelson is only too aware that nothing will shift overnight.
“This will take time,” he predicted. “In thinking about our metrics at Morgan Health, we are thinking about fiver-year outcomes and we can’t be responsible for getting it fixed in one year.”
That conservative timeline is smart given how Haven — J.P. Morgan’s previous effort with Amazon and Berkshire Hathaway to solve the employer-based healthcare puzzle — fizzled.
Photo: adventtr, Getty Images
