Bolton Labor News Edition No. 8: March 2024

Pulse of the Purchaser: Part 2 of 2

In December 2023, the National Alliance of Healthcare Purchaser Coalitions conducted a national survey of health plans assessing benefit purchasers’ concerns and views around workforce environment, health strategies, fiduciary perspectives, hospital pricing strategies, pharmaceutical drug strategies, high-cost claims strategies, and potential health reforms. The survey received 172 responses from private and public purchasers representing organizations spanning all sizes, industries, and geographic locations across the United States. Here are the takeaways:

• 88% of plan sponsors believe hospital prices are unreasonable/indefensible. The most popular strategies to mitigate hospital prices are centers of excellence/bundles (41%) and sites of care, such as an infusion therapy treatment center (37%).
• Going forward, plan sponsors are considering implementing advanced primary care health centers (57%) and tiered networks (56%) within the next one to three years.
• Health plans are asserting greater financial control of their PBM relationships through data ownership (63%), eliminating advisor conflicts (57%), and full audit rights (55%).
• Key areas for consideration over the next one to three years include full disclosure of all revenue streams (63%), transparency regarding net cost by drug (59%), and comprehensive definition of rebates (49%).
• Most health plans believe their formulary promotes biosimilars (69%) and removes low-value drugs (50%). Value-based formulary (49%) and customized formularies (43%) are among the key areas for consideration over the next one to three years.

Contact your current Bolton advisor or Stuart Sutley for assistance.