65

23

Member Companies

Educational meetings and roundtables hosted

21Health fairs attended

320,000Lives covered in Pharmacy

Management Initiative

25,000Flu shots administered

Over

In its 36th year, the St. Louis Area Business Health Coalition (BHC) and its employer members reaffirmed their commitment to improving population health and the quality and overall value of health care. We appreciate the many community partners who have shared their perspectives and engaged with us to further this aim. Only by standing together will we be able to achieve the health care we all want and deserve.

A Year of Listening and Learning in our Pursuit of Better Value

The BHC and the Midwest Health Initiative (MHI) hosted Voice of the Community Conversations to better understand the perspectives of others regarding barriers to higher-value health care. The BHC is grateful to the almost 100 community partners who shared their wisdom. Employers, unions, and benefit consultants were not the only ones concerned about health care cost. Providers and other suppliers reported that it decreased demand for their services, left patients unable to afford medications or treatments, and contributed to bad debt.

The consensus was clear that many of these challenges can only be solved by communities working together. The BHC has taken this feedback to heart, aligning its actions with these shared priorities.

Collaboration to Reduce Avoidable Emergency Department Visits

Missourians are more likely to visit an emergency department (ED) than people elsewhere in the country. This can result in overtreatment, wasted money, and missed opportunities to build patient and primary care relationships that lead to more

effectively-managed chronic conditions. Informed by data from the Midwest Health Initiative, BHC members partnered with health plan, medical group, hospital, benefit consultant, and urgent care representatives to explore ED overuse and plan coordinated actions to encourage appropriate ED use.

Trends in ED and urgent care use were analyzed. Using a conservative definition of when a visit is “unnecessary,” it was concluded that at least 15% of ED visits were for complaints that could have been better treated in a doctor’s office. An evaluation of levers to reduce unnecessary ED use through community education, benefit plan design, and provider incentive payments led to the creation of “playbooks” that offer steps to improve the appropriateness of ED use and encourage patients and primary care providers to discuss where and when to seek care. Download the employer or provider playbooks here: www.midwesthealthinitiative.org.

Aligned community efforts are already having an impact. MHI’s Community Scorecard indicates a 5.4% decrease in ED visits per 1,000 commercially-insured people between 2014 and 2017. The BHC is grateful to Bruce Hanson, Director, Compensation Processes, with The Boeing Company for his leadership in this effort. See more updates from the campaign on social media using the hashtag #PCPbeforeED.

Emergency Department (ED) Visits Per 1,000 PeopleCommercially-Insured Populations in St. Louis

1002014 2015 2016 2017

120

140

160

Num

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f ED

Visi

ts P

er 1,

000

Year

180

200

Barriers to High-Value Health Care1. Insufficient knowledge among the public about health care

2. Too few primary care physicians and high rates of physician burnout

3. Growing numbers of people with diabetes, obesity, and other chronic conditions

4. The opioid crisis

5. Overuse and variations in care, such as in emergency department visits and end-of-life care

Shedding Light on Health Care Value

The St. Louis Health Care Industry Overview (HCIO) report provides the community with information on the region’s progress towards the Triple Aim: better health, improved patient experience, and lower cost of care. Nationally and locally, the implementation of value-based payment programs continues to deliver improvements in health outcomes and safety. The 2018 report sheds light on hospitals that offer patients the “best value,” as illustrated by comparing a hospital’s Medicare star quality rating (an aggregate measure of safety, quality, and service to patients) to its average payment. The outpatient section of the report provides expanded information from www.ChooseWellSTL.org on how often patients in the St. Louis region receive recommended care. The publication also highlights the participation of top practices in programs that measure performance based on care quality, Accountable Care Organizations, and the Medicare Advantage networks. To view a list of the 57 measures in the CMS star quality program, as well as the 2018 HCIO reports and infographics, please visit www.stlbhc.org/HCIO.

Weighing In: New Considerations for Addressing the Obesity Epidemic

With one in four meals consumed at the workplace, businesses play an important role in creating an environment that encourages healthy eating. Supported by the American Heart Association and the National Alliance of Healthcare Purchaser Coalitions, the BHC developed educational opportunities and resources to assist employers in addressing employee nutrition and obesity in the workplace.

A survey collected insights from 40 employers on challenges and the availability of nutrition-related programs, policies, and environmental supports in the region’s workplaces. Results identified a greater need for data collection on employee nutrition risks, as well as the implementation of purchasing and pricing policies for workplace catering, cafeteria, and vending options. BHC Senior Director, Lauren Remspecher, was invited to present an overview of the survey results and recommended strategies at the Health Enhancement Research Organization (HERO) Forum in October. A full summary of the results is available for download at www.stlbhc.org/page/nutrition.

In April, the BHC hosted a community dialogue on obesity, attended by 230 representatives from 124 local organizations. Guided by topicexperts, the half-day program delved into the pathology of obesity, emerging clinical treatments, the impact of mental health and stigma on weight loss and regain, and best practices for addressing the workplace nutrition environment.

Through a new partnership with St. Louis MetroMarket, the BHC expanded opportunities for fresh produce access at St. Louis worksites. Serving as a farmers’ market on wheels, the MetroMarket now schedules two-hour visits to business locations, enabling employees to shop for fruits, vegetables, spices, and healthy snacks to-go. BHC members Ameren and Lutheran Senior Services hosted the bus at their campuses this summer, with a total of 888 pounds of produce sold to employees. The BHC is also eager to continue its work with Operation Food Search, a non-profit dedicated to ending hunger in the St. Louis MSA, to develop a workplace pilot program with environmental assessments, dietitian consultations, policy and vendor contracting support, onsite cooking demos, and volunteer opportunities. Contact Lauren at lremspecher@stlbhc.org to learn more.

Pharmacy Management Options Grow

Representing 43 employers and over 320,000 lives nationally, the BHC’s Pharmacy Management Initiative offers best-in-class pricing, analytics, audits, annual price checks, and an employer-friendly contract. Industry- and company-specific trend analysis allows for timely and accessible reporting, enabling members to maximize the value of their drug spend while planning for new and evolving therapies.

In 2018, a competitive bid and comprehensive evaluation of proposals led to the addition of OptumRx as a second Pharmacy Benefit Manager (PBM), along with

longtime BHC partner, Express Scripts. In addition to competitive pricing, both organizations bring strong data analytic capabilities and dedicated coalition account management to inform employers’ benefit strategies. Aggregate results hold promise for another year of flat or negative drug trend. To learn more about the BHC’s approach, please contact Dave at dheaton@stlbhc.org.

BHC LeadershipThe BHC is grateful for the committed leaders that guide its future course and community partnerships. The BHC’s Board brings a deep understanding of employee benefits and a strong desire for transparent and high-value health care. The coalition has thrived under the leadership of Carolyn Plummer, Bayer-Crop Sciences (previously Monsanto Company), who ended her tenure as Board President in January. The torch was passed to Tim Sutter, a seasoned human resources professional from Caleres and longtime BHC partner. The BHC welcomes John Rocco, Senior Manager of Employee Benefits for World Wide Technology, as a new Board member in 2019, and extends its sincere thanks and congratulations to Dolores Ennico, Vice President of Human Resources at Olin Corporation, as she steps off the Board to enjoy her retirement.

Next Steps for Employers in Combating Substance Abuse

U.S. Health and Human Services Regional Director, Jeff Kahrs, opened the BHC’s recent forum on opioid use with a sobering fact: St. Louis is a hotbed for overdose deaths. For almost a decade, employers have worked to decrease the number of opioids prescribed to their enrollees, and recent data (see graph below) illustrates success. Yet, substance abuse remains a serious problem. Employer attention is needed on return-to-work policies and the identification of evidenced-based recovery programs. The BHC looks forward to identifying best practices through engagement with the St. Louis County Department of Public Health and the St. Louis County Council Opioid Task Force on the #RecoverSTL Action Plan.

Monitoring Local and National Health Policy Changes

Since its inception, the BHC has served to bring the employer voice to local, state, and federal health policy issues. Collaboration with the ERISA Industry Committee and other national health policy groups in 2018 facilitated BHC’s focus on several regulatory changes, including those related to emergency care billing, air ambulance pricing policies, and the modernization of Health Savings Accounts. Moving into 2019, the BHC will continue to educate members on important legislative updates through ongoing Health Policy Webinars and the addition of a new resource page on the BHC website. For questions regarding emerging regulatory trends, please contactBridget at bhaegmontroy@stlbhc.org.

Priorities for 2019 and Beyond

In keeping with BHC’s mission and strategic objectives, while also addressing the barriers to high-value health care identified by community partners, the BHC has prioritized three focus areas for its attention and collaboration going forward:

1. #DefeatDiabetesSTLWith over 114 million U.S. adults having prediabetes or diabetes, significant opportunity exists to decrease risk factors and enhance the well-being of diagnosed individuals. During the 2018 Spring Forum, the BHC launched the Defeat Diabetes STL campaign. Led by an employer workgroup, and with the support of local physicians and community partners, the project will explore aligned strategies to prevent, better manage, and reverse diabetes. The creation of an inventory of employer and provider efforts to address prediabetes and diabetes is currently underway. To learn more, please contact Lauren at lremspecher@stlbhc.org.

2. Engaging Consumers and Unleashing their Purchasing Power A challenge that surfaced in every Community Conversation hosted by the BHC was the public’s lack of understanding about how health care works and how we all contribute to a high-cost and low-value system. To address this concern, the BHC is working to increase public awareness and nudge consumer activation toward better health, safer care, higher quality, and smarter spending. As a first step, the BHC is collecting suggestions from a wide net of partners to identify key messages. To provide your input, please contact Brenna at bkaroly@stlbhc.org.

3. Aligning Purchasing Strategies for Better Value Employers want more value for their investments in health benefits, and they look to their health plan partners to use their provider contracts and consumer engagement skills to deliver on this goal. Priorities include stronger relationships between patients and their primary care providers; enhanced care coordination and chronic condition management; safer care that is consistent with current recommendations for best practices; and less spending on services with little or no clinical value. An exploration of opportunities to support health plans in creating plan offerings that deliver on these goals is underway.

Opioid Scripts Per 1,000 PeopleCommercially-Insured Populations in St. Louis

2014 2015 2016 2017

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300

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MEMBERS:

2018 BHC BOARD OF DIRECTORS:

AAF International Aegion CorporationAmeren CorporationAnheuser-Busch Companies, LLCArch Coal, Inc.TheBANK of EdwardsvilleBarry-Wehmiller Companies, Inc.Bass Pro Shops, Inc.Bayer-Crop SciencesBi-State Development/MetroThe Boeing Company Bunzl Distribution USA, Inc.CaleresCharter CommunicationsCity of St. LouisConcordia Plan ServicesCushman & Wakefield Daikin Applied Americas Inc.

Diocese of Springfield in IllinoisThe Doe Run Company Drury Hotels Company, LLCEdward JonesEmersonEmmaus HomesESCO Technologies Inc.Ferguson-Florissant School District Francis Howell School DistrictGlobal Brass and Copper, Inc.Graybar Electric Company, Inc.Laird Technologies Inc.Maines Paper & Food Service, Inc.McCarthy Holdings Inc.MilliporeSigma Mississippi Lime CompanyNorth American Lighting, Inc.Northwest R-I School District

Olin CorporationPanera, LLCParkway School DistrictPeabody EnergyRockwood School DistrictSaint Louis County Saint Louis Public SchoolsSchnuck Markets, Inc.Shelter InsuranceSpire, Inc.St. Louis Graphic ArtsSulzer US Holding, Inc.Sunnen Products CompanyTucson Electric PowerUniGroup, Inc.Watlow WestRock Co.World Wide Technology, Inc.

SUSTAINING MEMBERS:Aon HewittLockton Companies, LLCMercerWillis Towers Watson

The BHC is an association representing over 60 forward-thinking employers in their efforts to advance the value of health benefits and the well-being of our community.

HEALTH CARE HR PARTNERS:Centene CorporationExpress Scripts, Inc.Lutheran Senior Services Mallinckrodt PharmaceuticalsPPR Talent Management GroupSaint Louis UniversityUniversity of Missouri

St. Louis Area Business Health Coaltion 8888 Ladue Road, Suite 250 St. Louis, MO 63124 314-721-7800 www.stlbhc.org

Beth BiggsVice President, BenefitsCharter Communications

Dolores Ennico Vice President, Human ResourcesOlin Corporation

Judy FairesDirector, Welfare PlansEmerson

Andrew FondowAssistant Vice President, Product StrategiesConcordia Plan Services

Gail FryeSenior Director, Compensation and BenefitsPanera, LLC

Debbie HanlonVice President, Human ResourcesESCO Technologies, Inc.

Bruce HansonDirector, Compensation ProcessesThe Boeing Company

Brian HaschmannDirector, Health & WelfareAnheuser-Busch Companies, LLC

Marla LangenhorstDirector, Benefits & HR TechnologyAmeren Corporation

Mark MispagelManaging Director, Compensation & BenefitsSpire, Inc.

Carolyn PlummerHealth & Welfare Benefits LeadBayer Crop-Sciences

Kristine SchusterVice President, Human ResourcesMississippi Lime Company

Ed StrouthDirector, Health & WellbeingBarry-Wehmiller Companies, Inc.

Kevin SuppleChief Operating OfficerFrancis Howell School District

Tim SutterSenior Director, Benefits & Risk ManagementCaleres

David TobenDirector of BenefitsBi-State Development/Metro

John ZieglerChief Commercial OfficerArch Coal, Inc.

Ex-Officio Member

Bob WaldRetired ExecutiveSmurfit-Stone

Bold text denotes Executive Committee Member