What do Jeff Bezos, Warren Buffett and Jamie Dimon have in common? They all tried to solve healthcare through Haven, a healthcare company created through a joint venture by Amazon, Berkshire Hathaway and JPMorgan Chase — and it failed, said Katy Spangler, senior advisor of American Benefits Council. Haven, which aimed to battle rising health costs for employee healthcare, shut down in 2021.
“I think we all deserve a little grace for how hard this is if those three tried working together and it didn’t work,” Spangler said to a roomful of employers Tuesday during the Midwest Business Group on Health conference in Chicago. The American Benefits Council is a trade association that advocates for employer-sponsored insurance.
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Amid the difficult environment in healthcare, Spangler added that it’s important to recognize that there have been several wins for employers in recent years:
- The No Surprises Act
Implemented in January of 2022, the No Surprises Act protects patients against most surprise medical bills when they receive care from out-of-network providers. Because of the No Surprises Act, about 1 million surprise bills are prevented each month, Spangler said.
“We really worked to recruit diverse stakeholders, including employers, including unions, including patients, including consumers,” she said. “And we did it, so really just continuing to look at that model for how we can apply that in the future I think is really important.”
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- Prohibition on gag clauses
The gag clause prohibition prevents health plans from entering into provider agreements that would stop them from disclosing cost or quality of care information to beneficiaries or plan sponsors. Each year, health plans have to submit an attestation to confirm they complied with the gag clause prohibition, with the first attestation due this upcoming December 31.
“There’s a rule of law that says that employers have to be able to get their data from their administrators,” Spangler said.
- Transparency
The Hospital Price Transparency rule went into effect in January of 2021, and helps patients know the cost of a hospital service before they receive it. Then in July of 2022, health plan transparency went into effect, which allows consumers to know the cost of a covered item before they receive care.
Spangler noted that while it was the Trump Administration that finalized these rules, price transparency actually originated in the Affordable Care Act.
“Fast forward to the Trump Administration, it took that long to really push ahead those goals,” she said.
While there have been some wins, there’s still work to be done, Spangler said. One area that needs focus is hospital consolidation.
“This is a phenomenon that we’ve seen where a hospital practice gobbles up a physician [practice], another hospital in the area,” Spangler stated. “Maybe they change the sign on the door and now what was a physician practice is now considered a hospital outpatient department and that hospital outpatient department is now going to command a higher reimbursement.”
Photo: Jirsak, Getty Images
