All businesses in the United States, from the mom-and-pop groceries to retail giants like Walmart, have an interest in health care. Whether they are health care providers, innovators, or purchasers, businesses can bring knowledge and a drive for innovation to the health care sphere.
ACEP Now Editorial Advisory Board member Ricardo Martinez, MD, FACEP, chief medical officer and vice president of North Highland and assistant professor of emergency medicine at Emory University in Atlanta, recently spoke with Jennifer Pierotti, director of health policy at the U.S. Chamber of Commerce, about how physicians and businesses can work together to create an innovative health care environment and provide the best care for patients. Here are some highlights from their conversation.
Dr. Ricardo Martinez: Tell us about the U.S. Chamber and who it represents.
Jennifer Pierotti: We are the world’s largest business association. We represent the interests of over three million businesses from every size, sector, and region. Our members include everyone from local and state chambers, the mom-and-pop stores on the corner, to industry associations and international corporations. We have a broad array of interests as well as policy issues that we develop.
RM: I attended the Chamber’s Annual Health Care Summit on innovation, and it was terrific to see the breadth of people on the business side and also the entrepreneurial side who are focusing on health care.
JP: Our Annual Health Care Summit is a chance to step away from looking at the political realities and driving policy issues of the day and look at the folks on the frontlines of delivering health care. We can talk about how doctors use telemedicine to access rural areas and new clinical trials happening at places like the Cleveland Clinic—areas we don’t get a chance to look at on an everyday basis.
RM: I think emergency physicians would be surprised at how much the Chamber is involved in health care. Tell us more about where the business community sees itself in the health care landscape.
JP: A lot of businesses in the health care space, like the companies creating cutting-edge pharmaceuticals or hospital systems, are coming up with new delivery models or the latest health care technology. In addition to private-sector innovations, businesses are employers and are on the frontlines of being the providers of health care coverage to their employees. They have been dealing with the challenges of our health care system way before the Affordable Care Act. Finally, employers are uniquely positioned to deal with some of the wellness and chronic disease issues individuals are facing these days because employees spend about two-thirds of their work day at their place of employment.
RM: The rollout of health care reform has created a changing landscape, and different areas are evolving at various rates. What are the most important issues that the Chamber sees as needing to be tackled?
Right now, if you’re a doctor and you want to treat your Medicare patient in another state using telemedicine, you have to be licensed in both states. This is a great example of a regulatory barrier that could use additional flexibility so we can open up these channels of care. —Jennifer Pierotti, director of health policy at the U.S. Chamber of Commerce
JP: In order to keep all of this private-sector innovation going, what sorts of regulatory reforms need to take place? What parts of the Affordable Care Act do we need to address so that employers can keep doing what they’re doing? The Chamber as a whole has a regulatory reform agenda that promotes changes like more transparency and longer comment periods for the regulatory process. Reforms like this are meant to ensure that businesses aren’t battling red tape and can continue to create health care startups and innovate. Much of the health care law was written through the regulatory process, and it went much faster than it should have gone given the complexity and scope of many of these health care regulations. Our main priority right now is reducing the impact of the employer mandate.
RM: Many of our readers would be surprised to know that there are a lot more private health care exchanges than public ones, spawned as business began to move away from defined benefits and toward defined contributions. As business moves from being the sole source of insurance to being a partner with the employees for insurance, what can we expect to see from business in terms of working with their employees to ensure that they have health coverage?
JP: The biggest thing we’re seeing now is the shift to a new consumerism in health care. Despite some of the mandates on the insurance market, employers are looking to how they can use cost sharing to get their employees the best deals and options for coverage. They’re investing in things like health reimbursement arrangements, flexible spending accounts, health savings accounts, and different ways employees can get more bang for their buck. We’re going to see more of that as employees are seen as the consumers, rather than recipients, of health care on a much wider scale.
RM: Are employers trying to make it simpler for the employees to make better decisions?
JP: Definitely. Health insurers are focusing on better communications with employees to try to break down what employees are getting for each plan being offered. This is not just the summary of benefits and coverage that employers have to provide but really speaking to the employees in terms that make sense: “This is what you had last year. This is what is different this year.”
Built into the private exchanges you mentioned is a feature where members can have direct contact with benefit advisors who can tell them what they’re getting. Of course, a lot of this is done online, and there are strong efforts focused on figuring out what formats are easiest for people to understand, what kind of information they are looking for, and real-life examples of “if he gets this procedure, it’s going to cost this much.”
RM: That last part especially is important to emergency medicine because we frequently have patients with high-deductible plans. Our ability to take care of them and then get paid can be a challenge, especially if it’s a complicated patient. The other side of the coin is that that high deductible has really generated a large amount of competition for those first dollars in terms of the urgent care clinics and retail clinics. What do you see in that growth of consumerism and the first dollar affecting the growth of new types of businesses in the market?
JP: We’re at an interesting place in the implementation of the Affordable Care Act. There’s this whole new group of low-income people and “young invincibles” who now have access to coverage but still have trouble accessing care. If you’re low income, you can’t always leave work as easily or miss those working hours to go to the physician’s office. As a country, we’re still working through issues of where people are ending up in the access process. It is a learning experience both for the employees and consumers of health care, as well as the providers.
RM: Virtual care and telehealth have been slow in the uptake but are now accelerating. Do you have any insight into that from the business side?
JP: We’ve seen a huge emergence of health information technology, and everybody always assumes that more technology is better in whatever form.
Of course, we hear a lot from the physician side that electronic health records are really slowing them down. It’s causing dissatisfaction in the workplace for physicians. But we’re seeing more innovation in this space to make technology more useful and even tailored to physicians based on specialty.
On the other hand, telemedicine has shown it is a great way to reach some of these newly-insured populations, especially low-income populations and rural populations that don’t have the same access to physicians as compared to large cities or high-income areas. As the U.S. Chamber, we’re working toward getting rid of some of the barriers to using this telemedicine as a targeted tool to increase access to care. Right now, if you’re a doctor and you want to treat your Medicare patient in another state using telemedicine, you have to be licensed in both states. This is a great example of a regulatory barrier that could use additional flexibility so we can open up these channels of care.
RM: As hospital-based physicians, a lot of times we find ourselves being very insular or working within our hospital, but it sounds like there’s a need for us to reach out to the business community. From your experience, what would you advise physicians in order to start an effective and meaningful dialogue with business?
JP: The perfect place to start is your local or state chamber. We’ve seen a number of groups develop regional health care collaborations at the local or state level. For example, Nashville, Tennessee, has a health care effort led by the Nashville Area Chamber of Commerce that pulls together all of the health-sector players in that area—hospitals, physician groups, and businesses—and they all figure out the challenges together for the area. They’ve been able to move forward with creating cultures of wellness, making sure that they have adequate hospital and emergency room service and ensuring the business environment is supporting the local health care industry. At the end of the day, if these groups are insulated from the others, they can’t collectively deal with the problems and come to a solution that’s best for that geographic location.