Missouri’s 103rd General Assembly began on January 8th, and since its commencement, numerous bills have been filed that threaten employer flexibility in health benefit plan design and impact employers’ ability to uphold their fiduciary responsibilities.

Overseen by the Department of Labor, the Employment Retirement Income Security Act (ERISA) clearly defines the fiduciary standards required of the individuals that make decisions related to employer-sponsored health benefit plans. They must:

1. Act solely in the interests of plan participants and beneficiaries;
2. Carry out their duties prudently;
3. Follow the plan documents (unless inconsistent with ERISA);
4. Hold plan assets (if the plan has any) in trust; and
   
5. Pay only reasonable plan expenses.
   

Every ERISA plan must have at least one person identified and accountable for having decision-making power over the health plan’s fiduciary actions. The duty to act prudently, a central theme of ERISA oversight, focuses on the diligence exercised in the processes and evaluations leading to fiduciary decisions. It requires expertise in a variety of areas and the ability to seek the best value on behalf of plan participants. 

Accepting this responsibility, employers invest heavily in the education and training of their internal team and enlist the expert guidance of an array of benefit consultants, actuaries, and clinicians. When selecting an administrative partner, such as a PBM, numerous vendors are thoroughly evaluated, extensive financial modeling occurs, and prices and contract terms aggressively negotiated. 

Benefit managers, HR professionals, executive leaders, and Boards of Directors fully appreciate the seriousness of their fiduciary responsibilities in administering a health benefit plan under ERISA and the potential liability that exists if they are found not to act in the best interest of plan enrollees. Some organizations name an administrative committee or their Board of Directors as their fiduciary, and most require the final approval of fiduciary benefit decisions to be reviewed and approved at the highest levels of the organization before enacted. 

So, it is incredibly frustrating when legislative bodies bring forth bills that directly interfere with an employer's fiduciary responsibility to its plan participants, such as Missouri Senate Bill 45. This bill places the financial interest of independent pharmacists over the financial interest of Missouri employers, workers, and their families. It disregards the commitment and effort undertaken by ERISA plan sponsors to act solely in the interest of plan participants and carry out their duties prudently. On behalf of its members, the BHC has submitted a testimony to the Senate Families, Seniors and Health Committee opposing Senate Bill 45. The testimony outlined BHC’s concerns surrounding reduced pharmaceutical competition, increased costs, and constrained plan management strategies.

While advocating on behalf of Missouri employers, we recognize the difficult challenges faced by brick-and-mortar retailers and empathize with the small independent pharmacies. These are difficult times for most businesses and many families. But it is not the time to pass legislation which favors one business model over another, especially when consumer behavior trends clearly demonstrate a continued and accelerated preference for online and home delivery services. It is not the time to take programs demonstrated to be effective in reducing cost off the table.

We will continue to follow this and other legislation that puts employer benefit plan design at risk and threatens their role as fiduciaries. We welcome your input and engagement—please reach out with any questions you may have or to share your thoughts. 

BHC’s April 25th Community Forum, On the Cusp of a Cure: Advances in Cancer Treatment, is just around the corner. Cancer is and has been the second leading cause of death in the United States since 1938. In preparing for the program, I found some jarring, yet uplifting, statistics. 
  

• U.S. cancer deaths increased almost every year during the 20th century. It’s hard to imagine but the percent of Americans that smoked in the 1960s was over 40 percent. Gallup reports that 12 percent of Americans smoke in 2023. 
   
• Cancer deaths peaked in 1991, when 215 out of every 100,000 deaths were caused by cancer and then began to fall each year. 
   
• The overall cancer death rate in the U.S. fell 32 percent between 1991 and 2019 resulting in almost 3.5 million fewer cancer deaths. The steepest annual declines occurred in the immediate pre-pandemic years, dropping about 2% a year from 2015 through 2019 compared to 1% a year during the 1990s.
   
• To put today’s incidence and mortality in perspective, 2020 statistics show that one in every five deaths in the U.S. is due to cancer and one in every three people are expected to have cancer in their lifetime.
  
  

The drop in tobacco use is credited with the large reductions in cancer deaths at the end of the last century and demonstrates the power of prevention. The more we learn about cancer the more we understand the potential to further reduce cancer deaths by focusing on lifestyle choices. Community Form speaker, Dr. Dawn Mussallen, Integrative Oncologist and Cancer Survivor, Mayo Clinic, will share research findings that link lifestyle choices to reduced cancer incidence and sustain cancer survivorship today. 

Increased attention to screening and earlier detection, as well as a better understanding of how cancers grow and spread, have also contributed to a reduce rate of cancer deaths. The latter has led to more precise treatments that can control and even cure some cancers. Targeted chemotherapy, immunotherapy, and powerful combination treatments can give patients greater quality of life and longer lives. Director, Center for Gene and Cellular Immunotherapy at Washington University School of Medicine, Dr. John DiPersio, will simplify and share the promise of immunotherapy and precision medicine. 

Accelerating declines in the cancer death rate show the power of knowledge and actions to move closer to a world without cancer. Please join with other BHC and community members for this important conversation.
 
Warm regards,

Louise Y. Probst
BHC Executive Director

After 20 years of service, Louise Probst has announced her retirement as the Executive Director of the St. Louis Area Business Health Coalition (BHC) and the Midwest Health Initiative (MHI). BHC advocates for better health, care quality, and more affordable health care on behalf of the region's employers and workers. Under her leadership, BHC has played a pivotal role in advancing transparency of health care cost and quality information and shaping collaborative solutions to the health care challenges that face employers. Through MHI, a separate nonprofit, Louise facilitated commitments from those who provide, pay for, and use health care to share information and develop regional solutions to problems that vex our health care system.

“My time at BHC and MHI gave me the opportunity to bring the purchaser and worker perspective to health care conversations locally and nationally. That’s truly been an honor,” says Probst. “It has been meaningful, fun work with smart people who care about our region.”

John Ziegler, Senior Vice President, Arch Resources, Inc., BHC’s Board President, stated, “Louise has been the driving force behind the St. Louis Area Business Health Coalition's commitment to advancing health care quality and affordability. Her visionary leadership, coupled with an unwavering dedication to the well-being of our community, has set a standard of excellence that will resonate for years to come."

The BHC Executive Committee has begun the important work of finding a new leader, passionate about the organization’s missions of improving health and health care value. Interested parties may send their resume and cover letter to Michelle Anderson, Vice President of Executive Search, OMNI Human Resource Solutions, manderson@omnihrm.com.

There’s a workplace mental health crisis in America, according to the 2022 Workplace Report by the Society for HR Management (SHRM). This sentiment is consistent with a top concern shared by BHC members pre and post COVID-19. The report finds that burnout, exhaustion, and hopelessness are more common among workers than ever, and that pandemic-related stressors linger, all chipping away at productivity. It seems that the pandemic catalyzed already present behavioral health challenges, increasing symptoms of mental distress while creating barriers to resources and care worldwide. It’s likely that the disruptive changes in society and public discourse contribute as well. 

According to the World Health Organization, rates of depression and anxiety have both seen a significant increase following the pandemic, and a 2021 survey found that a staggering 52% of employees reported experiencing burnout, increasing nine percent from the prior year. As we approach the cold, dark winter months, this time of year serves as a reminder of the importance of taking steps to support the mental well-being of ourselves, co-workers, and family members. While large employers offer benefits that include behavioral health care, SHRM finds a gap: people with mental health needs often do not access services, suggesting that employees may not be aware of the resources provided by their employers and A Milliman Report, noted multiple prior research studies that found a considerable lag between the onset of behavioral health symptoms and the beginning of treatment, with one study finding an astonishing 11-year gap.   

Behavioral health symptoms exist on a broad spectrum, ranging from mild to severe. Today, the National Institute of Mental Health (NIMH) reports that one in every five American adults is affected by a mental illness, with many more in the population experiencing various behavioral health issues. The World Health Organization estimates that each year anxiety and depression cost the global economy a staggering one trillion dollars, largely due to decreased productivity, and a Milliman Research Report states that those receiving care for any mental health issue have a total health care spend 3.2 times higher than those receiving no behavioral care. Interestingly, the SHRM report found that 41% of HR professionals don’t believe their organization offers enough mental health support for employees. The behavioral health of the workforce and the economic well-being of the corporation align. Getting and staying ahead of the curve is crucial for the well-being of employees and the company.

The SHRM report cited above does explore actions taken by employers beyond offering access to an EAP program and behavioral health services in their health benefits. I found two interventions of particular interest. One is offering mental health training programs, or more aptly referred to as resilience training for their workforce.  The other is taking measure of the mental health state of their workforce annually to understand progress and changes over time. Three measures were most common: 1) questions on employee engagement surveys (cited by 48% of HR professionals), 2) mental health resource utilization rate reports via their EAP or claim data (47%), and attendance and productivity data (43%).   

Primary care providers are well positioned to support employee’s behavioral health needs. Hence, the national call to integrate behavioral health into primary care—an action that could improve the population’s access to care, reduce barriers to seeking care, and promote whole person health. Employers can encourage or reward their employees for having a regular source of primary care, ask their health plan to provide them a report annually, on the percent of their enrolled population that has an established primary care relationship.  Health plans have been slow to recognize primary care practices in their networks that offer integrated behavioral health services at their practice site. Employers can inquire with their health plan about their efforts to recognize and expand integrated behavioral health care and to recognize these practices in provider directories for employee knowledge. A healthier America is a more productive America, lets all work toward this goal in 2024.

Warm regards,

Louise Y. Probst,
BHC Executive Director