Healthcare is full of complex terminology, often summed up by initialisms. Certain groups of hospitals and doctors are "accountable care organizations," or ACOs. Health savings accounts are HSAs. The landmark Affordable Care Act is the ACA.
That shorthand can be intimidating for an outsider (or even an HR professional), so it helps to have people who know their ABCs. For the last five years, one of the highest-profile translators for employers has been Brian Marcotte, president and CEO of the National Business Group on Health (NBGH), a non-profit advocate for employers and their health plans based in Washington, D.C.
Marcotte, who has led NBGH since his 2014 appointment, is retiring May 1, 2020. His tenure has marked a shift on the subject for employers, who now view healthcare as more than the programs delivered by benefits departments. "Healthcare is becoming an integral part of employers' workforce strategy," Marcotte told HR Dive in an interview. "There's a lot of other things that employers can branch out into."
At NBGH and elsewhere, those in the private sector are starting to talk about concepts like holistic well-being, which expands the definition of health beyond individual conditions to include preventative aspects as well as mental and emotional health. There's also a discussion about the role communities play in delivering healthcare, Marcotte said.
But progress has been slow on some fronts. "I don't think we're moving as a country enough on value-based care models," said Marcotte, explaining that the way U.S. workers pay for care factors into the issues the country's healthcare system faces, most notably it's ever-rising cost.
Getting everyone in the same room
Marcotte's past has shaped the way he approaches issues like value-based care. When he joined NBGH, Marcotte held numerous compensation and benefits roles at Honeywell, a Fortune 500 company. Transitioning between these two roles brought with it a perspective shift, he said. "When you sit at that intersection you're no longer that single employer dealing with your healthcare patterns or your particular issues."
Being at NBGH means dealing with healthcare from a different seat — one that offers the opportunity to bring together those on different sides of a given issue, like physicians and insurers. It also can mean convening different large employers to think through shared problems differently. "One of the core values of the business group is our ability to convene stakeholders to drive change," Marcottte said.
He pointed to NBGH's Leave Optimization Forum, launched in 2018, which connects employers like Amazon, Facebook and General Mills with health industry players to talk about leave policies and how those affect employee health and well-being. Marcotte said the forum is an example of NBGH observing the trend of holistic well-being in employer health plans at a broad level and acting on it. "That's one of the rewarding things about this role. You get to drive change."
Holistic well-being is one of the areas Marcotte said he believes NBGH has impacted most during his tenure and one he hopes employers will prioritize moving forward. "The investments you make in the health and well-being of your employees need to be on par with the investments you make in safety and training," Marcotte said. "All of these things are out there to make your workforce as good as possible."
What lies ahead
There's no shortage of challenges facing the U.S. when it comes to paying for healthcare. Overall costs are projected to increase by 4% in 2020, according to Mercer. What's more, presidential candidates have popularized concepts like "Medicare for all" and other healthcare strategies that would variably impact the employer-sponsored healthcare model.
Marcotte acknowledged the trend but said that employers, in his experience, don't necessarily oppose such proposals. "They want the most affordable and effective model for their employees that can be sustained over time," he said. "They want the most efficient system for their employees."
The knock against those ideas is that they wouldn't move healthcare forward in their current forms, but would instead set things back, Marcotte said. Today's system is dealing with the unsustainable inflation, he said, but there's a need to drive greater accountability within that system. New proposals, he said, would need to have the right elements of value-based care. "It's not about protecting the employer-based system, unless it's more efficient."
Drug pricing also is a concern. "It has the potential to crush us," Marcotte said. "We have curative therapies that are fantastic, but at what price?" He said the problem is due in part to a "very entrenched business model" that is unsustainable. He added that some pharmacy benefit managers have taken it upon themselves to do things differently, though, and that other innovations could change things for the better.
Overall, Marcotte is most excited to see the continued growth of virtual care solutions. "Consumers believe virtual care is going to play a large role in the healthcare system of the future," he said.
Come May, however, Marcotte is hoping to give time back to his family after an extensive career both at NBGH and on the employer side. "I'm fortunate to have a 95-year-old father who still plays golf," Marcotte said. "I don't know if this will be his last season." He said he plans to stay active in healthcare discussions but didn't share any specific future ventures.
And as for NBGH, the organization will continue working to bring employers closer together and improve the health and well-being of employees under future president and CEO Ellen Kelsay, Marcotte said; "I think [NBGH] will continue to thrive as an organization."