JPMorgan's health arm launches policy guide to push value-based care in employer plans

Morgan Health encourages federal policymakers to prioritize reforms that advance and scale value-based care in employer-sponsored insurance plans.

“An overwhelming majority of Americans have yet to see the full benefit of value-based care — a growing disconnect from the federal government’s focus on advancing a value-based agenda in public programs,” said Dan Mendelson, CEO of Morgan Health, a business unit of JPMorgan Chase. “While employers have made meaningful strides to deliver innovative care and benefits to employees, there are longstanding barriers that require Congress and the federal government to act in tandem with the private sector.”

According to the latest market data, fewer than 13% of commercial insurance payments in 2021 were tied to two-sided financial risk for improvements in health outcomes, compared to more than 35% of payments in Medicare Advantage and 24% in traditional Medicare. These perverse incentives undermine employers’ ability to offer accessible, high-quality primary and accountable-care programs, the company said. Ultimately, they contribute to pervasive gaps in health outcomes among employees.

Although health-care payment, delivery and quality depend on clean, consistent data, barriers facing employers, health plans and providers continue to hinder meaningful data collection, use and reporting. Federal policymakers can address these barriers, according to Morgan Health’s Policy Reforms to Improve Employer-Sponsored Insurance policy guide, by:

• Finalizing a recent proposal to create a centralized, national provider directory;
• Modernizing the existing HIPAA statuteto better reflect current technological and business transactions so providers, health plans and third-party administrators can communicate safely, effectively and in real-time around care delivery; and
• Providing consistent standards for race and ethnicity data collection, use and reportingthat are aligned between the private sector and federal government, building on the forthcoming update to federal data and reporting requirements from the administration.

Related: Alliance calls on Congress to advance value-based care

Growth in the demand for whole-person health services has prompted greater interest in expanding the primary and behavioral health-care workforces to maximize the skills of non-physician providers. To expand access to these critical services, Mogan Health recommends that policymakers encourage accountable-care arrangements that promote primary care with full integration of primary behavioral health care, empower non-physicians’ ability to practice to the top of their licenses and improve reimbursement for behavioral health-care services.