Refocusing at the NBGH

As Brian Marcotte steps into his new role as president and CEO at the National Business Group on Health, he is urging HR leaders to look beyond the immediate effects of the Affordable Care Act.

Thursday, May 22, 2014
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"We have to refocus the conversation on what is really important," says Brian Marcotte, the new president and CEO of the Washington-based National Business Group on Health.

"There has been so much focus on access with the Affordable Care Act and the implications of the ACA. There has not been that focused attention around cost and quality. It doesn't sound very sexy or very stimulating because it's the same old same old, 'We've heard this before.' But, at the end of the day, it's what really matters and what's important to employers."

Earlier this month, Marcotte replaced Helen Darling -- the nonprofit's president since 2001 -- and he says his short-term priority is to help employers process the ACA's implications and options so they can get back to dealing with annual increases of 7 percent and higher in the cost of providing employee healthcare benefits. Marcotte, who has been an NBGH board member for 12 years, previously was vice president of compensation and benefits at Honeywell International, a $38-billion diversified manufacturing and technology company with 130,000 employees in more than 100 countries. He was responsible for strategy, design and implementation of global total rewards, executive compensation and the HR mergers and acquisitions process.

"I think the ACA has been such a huge distraction for employers," he says. "They are still trying to understand the new pathways, such as public and private exchanges, and options for delivering care. Everybody's jockeying for a position: Consultants and health-plan providers are willing to take on risk and play the role of insurer. You have all this activity going on and employers are struggling with how to navigate."

Marcotte says that it seems that "there is a lot of angst about trying to understand that right now. I think private exchanges are good because they create that healthy tension to try to innovate. They need to develop a case around how to improve delivery, quality and cost. That's the big question on the table for them."

Employers also are grappling with changes in delivery systems, as well as a rush to establish accountable-care organizations, he says.

"Employers love the concept, but they are struggling to understand the efficacy," Marcotte says. "That's critical. If you're going to ask an employer to go to an accountable-care organization, how do you know the company will get greater value? These organizations need to demonstrate that. An area where I think the business group can help is trying to work with stakeholders to figure out how to make that assessment."

For private exchanges, the business group offers a toolkit and is working with an actuary to develop a checklist for assessing exchanges.

One way the NBGH plans to help employers to better deal with ACOs will come as new products and toolkits become available to members, Marcotte says, adding that the group will work with health plans to design a "scorecard" to help employers assess value.

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"Employers can help identify what those markers will be in terms of outcomes," he says. "To sell it internally, [HR and benefits leaders] need a business case to take to the CEO. They need the data to demonstrate better outcomes than the market and at the same or better costs. What are the markers that demonstrate that? We are working with health plans and providers to determine what they are. You have employers working in certain markets that are further along than others. It's a matter of pulling that expertise together."

One of the benefits he says he always found in the business group "is that I believe that innovation in healthcare is driven by big companies. If you look at all the initiatives -- information technology, direct contracting, consumer engagement -- the business group is the one place where all that innovation comes together. If it's out there, we want to pull it in and share it with the broader membership."

Marcotte says his years at Honeywell primed him for helping employers and HR executives steer their efforts to ongoing issues, such as keeping up with rising costs.

"You have to have a relentless focus on managing costs and improving quality, in terms of your role day-to-day," he says. "Your focus has to be on managing healthcare costs and improving outcomes for your employees. It's a 24/7 thing. When you're faced with 7 to 10 percent trends this year, it's not about what we did last year, it's about this year.

"That's the way it should be," he says, "because of the impact on the bottom line. Status quo is not viewed as success, it's viewed as failure. To look at next year's health plan and say, 'We didn't make any changes,' that is viewed as a failure. It is a constant focus to reinvent yourself, just as businesses have to do."


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