St. Louis Area Business Health Coalition

The St. Louis Area Business Health Coalition's (BHC) mission is to support employer efforts to improve the well-being of their enrollees and enhance the quality and overall value of their investments in health benefits.

The BHC was created over 35 years ago to give area employers a collective voice on health care issues. Employers realized health care costs were rising fast. They founded the BHC as a forum to discuss why and find opportunities to improve health and health care. The BHC has evolved to offer innovative products and services, provide in-depth research on local health care trends and help foster a culture of wellness in the community. The BHC uses the power of its membership to negotiate optimum benefit opportunities and ensure the employer perspective is heard.
 
The BHC, a member of the National Alliance of Healthcare Purchaser Coalitions (formerly the National Business Coalition on Health), remains the only St. Louis area business group focused solely on health care issues. Employers have a responsibility to their employees and their communities to work toward a sustainable, value-driven health care system. The BHC understands this responsibility and supports employer efforts to inspire excellence in health care.
 
"Our nation's health care system has made tremendous gains in medical science, and we understand more about maintaining health than ever before. However, as a system and as individuals, we do not always live up to our potential." 

- Louise Probst, Executive Director
St. Louis Area Business Health Coalition

Profile of organization that was published in the February 2021 issue of the PCC Executive Member Update (e-newsletter):

The St. Louis Area Business Health Coalition (BHC) has been a PCC Executive Member since October 2019. Founded in 1982, the BHC has supported leading employers in enhancing the quality and overall value of their health benefit investments and improving the well-being of their employees. With more than 70 purchaser members providing health benefits to thousands of people in Missouri and millions nationally, the BHC recognizes the important opportunity for employers to align plan design and other incentives to advance primary care.
 
Using data from the Midwest Health Initiative (MHI), BHC employers have been monitoring primary care utilization, which has remained flat over the past four years, averaging 1.2 visits per commercially insured person in the St. Louis metro area in 2019. Annual spending on primary care professional fees, as a percentage of overall health service spending, ranges between 5.5% to 6.1% locally. In light of these trends, it was not surprising that Kaiser Family Foundation’s (KFF) State Health Stats reported emergency department (ED) utilization in Missouri to be 11^th highest nationally in 2015. Adding to the concern, MHI found that 15% of all visits to St. Louis EDs were potentially inappropriate, using a conservative list of diagnoses to determine care better treated in a primary care settings.
 
Armed with this data, in 2018 BHC and MHI formed a multi-stakeholder Collaboration to Improve Appropriate ED Utilization, funded by the Purchaser Value Network. Playbooks were developed to help employers and providers communicate with employees (patients) about the importance of establishing a PCP relationship and seeking care in the appropriate setting. Employers aligned financial incentives by lowering PCP visit copays and raising ED visit copays in non-emergent instances when the patient was discharged home. The BHC sent a letter to the region’s PCPs acknowledging the importance of primary care and encouraging them to ask their patients about ED use and identify better solutions for their acute-care needs. Participating medical groups provided training and scripts for office staff to use in patient conversations, flagging individuals with conditions that put them at high risk of potentially avoidable ED visits and offering standing orders to use when chronic conditions were exacerbated.
 
The impact of these efforts has been positive, with the most recent KFF report showing Missouri to have improved its ED utilization among all states, ranking 18^th in 2018. MHI data also shows progress among commercially insured people in St. Louis, with ED use decreasing from 162.1 to 158.8 visits per 1,000 people between 2018 and 2019. All of these reductions were found to occur among patients discharged home.
 
The shortage of PCPs nationally has also prompted employers to take steps to secure primary care access for employees via direct provider contracts and onsite or near-site clinics. A June 2020 survey of BHC members found that 42% currently sponsor a clinic for their employees, with another 15% considering implementation in the next 12 to 18 months. In the coming year, the BHC will continue to support its members in assessing the feasibility of these and other primary care models, capturing data on PCP use in these settings, and exploring opportunities to advance primary care through high deductible plans, as allowed under new federal rules.
 
To learn more about the BHC’s ongoing work in this space, visit its website or follow it on LinkedIn and Twitter.