AMERICAS AGENDA HEALTH CARE FOR ALL
1025 Connecticut Avenue NW 907, Washington, DC 20036 www.americasagenda.org

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Organizations Filed Purposes: To organize, educate, and build consensus among a wide range of labor, business, health care, citizen groups, and other diverse interests in support of adoption of health care policies that will assure affordable access to high quality health care for all Americans.

Over the course of 2018, America's Agenda: Health Care for All (AAHCA) program services continued to promote and expand delivery of higher quality patient care, while achieving more affordable overall health costs and a substantially improved patient experience. Throughout 2018, AHCA programs continued to focus on two core areas of high value care delivery transformation: 1) delivery of high-value, broad scope primary care, and 2) improved affordability of prescription medications. Concurrently, AAHCA supplemented its two core programs during 2018 with an expanded focus on complimentary areas of high-value care delivery transformation in support of the mission of New Jersey Governor Murphys newly established State Taskforce on Health Benefits Quality and Value.AAHCA continued its emphasis on transformation to advanced, high-value primary care design for two principal reasons: a) because robust provision of well-designed, broad scope primary care is the most cost effective means of preventing and cost-effectively managing chronic disease which accounts for 84% of overall health care spending in the US and b) scaling of well-designed, broad scope primary care offers significant leverage toward high-value transformation of secondary and tertiary health care delivery where, in the US today, most health care dollars are spent. AAHCAs added focus on affordability of prescription medicines over the last two years arises from the emergence of prescription medications as the most rapidly growing component of overall health costs. Attainment of the AAHCA mission of securing affordable health care for every American requires a solution to growth in cost of pharmaceutical medicines that currently outpaces significantly, not only US wages and GDP, but also the rate of growth in overall health costs.Principally as a result of this work in these two areas, AAHCA Executive Director Mark Blum was tapped by New Jersey Governor Murphy to represent AAHCA as an appointee to the NJ State Taskforce on Health Benefit Quality and Value. In support of this work, AAHCA expanded its focus from the two areas above to examine and submit recommendations regarding a number of complimentary areas of high-value care delivery transformation that included improved transparency of medical claims data, true independence of medical claims administration and adjudication (to reduce medical cost waste, fraud, and abuse), and improved patient access to high-value behavioral health services.Below are key AAHCA initiatives and accomplishments in these areas over the course of 2018:Detailed Program Activities:1. High-Value Primary Care Transformation - The statewide NJ Direct Primary Care Pilot Program that Americas Agenda designed was adopted by the State of New Jersey and implemented with AAHCA support to care for 800,000 eligible NJ public employees and dependents. The program also aims to allow private sector employers, employees and dependents to access the direct primary care medical homes established initially to serve public employees, thereby dispersing the benefits of higher value care across entire New Jersey communities. There have been significant challenges to contacting and educating eligible enrollees about the program, however. AAHCA has worked extensively to support a coordinated campaign by public employee representatives to overcome those obstacles. Approximately 2,500 eligible employees and family members have enrolled over the course of 2017. More than twice that number enrolled over the course of 2018. We are encouraged by our accelerating success in enrolling these public employee family members and by the very high rate of satisfaction they have expressed with their new health care experience. Yet looking ahead, we will need to accelerate the rate of enrollment growth in the New Jersey DPCMH program even further to achieve the DPCMH program scale objectives and to have a large enough group of enrolled patients to derive statistically significant measures of the impact that ready access to high quality, primary care with no out-of-pocket patient costs can have on the general health and overall health costs of a patient population. It is our contention, based on available evidence, that this design innovation will be foundational to the high-value transformation of, not only advanced primary care, but of overall health care delivery on which Americans future financial and physical health will depend.2. Design and Implementation of Effective State Strategies to Reduce Cost of Prescription Medicines - During the preceding year, 2017, the State of New Jersey had implemented the Americas Agenda-designed strategy to reduce prescription drug costs through creation of a dynamically competitive marketplace for selection of a pharmacy benefits manager, contracting of pharmacy services, and pricing of the prescription medicines. The result was a projected net savings to State taxpayers projected at $1.6 billion or 18.5% over the next 3 years under a radically transformed PBM contract. Over the course of 2018, the first year of these savings was achieved without any cut of prescription drug benefits. By the autumn of 2018, it had become clear that New Jersey State workers prescription drug savings actually exceeded projections and amounted to an historic prescription drug savings rate of more than 25%. (Please see NJ Governors report, 9/17/2018: https://nj.gov/governor/news/news/562018/approved/20180917a.shtml)AAHCA program activities continued forward from design of New Jerseys reverse auction competitive PBM market strategy to implementation of new State methodology for translating the resulting prescription drug savings into reduced State health plan premium growth. The result of this activity was a recalculation of State employees health plan cost changes for approximately 750,000 New Jersey School teachers and State and local government employees and their families. After recalculation, New Jersey school teachers overall healthcare premiums resulting from the Americas Agenda pharmacy marketplace redesign fell from a 13% increase in 2017 to an actual decline in overall 2018 health care premiums of more than 1.1% -- a reversal of overall health care premiums for NJ public school teachers of more than 14%. Similarly, State government employees and dependents health care premiums fell by 1.2% -- another reversal of a formerly unbroken trend of rising health care premiums over many years. (Again, please see Governors Report 9/17/2018: https://nj.gov/governor/news/news/562018/approved/20180917a.shtml)The success of AAHCAs New Jersey prescription drug savings initiative is particularly significant as a model for adoption by other states. As health care costs rose at an accelerating rate for health plans beneficiaries across America in 2018, other states witnessed health plan premiums for New Jersey State and local government employees and public school teachers, retirees, and dependents actually fell as a result of the success of the AAHCA campaign. During 2018, AAHCA took its message to other states such as Pennsylvania and Maryland that the fastest growing component of health costs, the costs of prescription medicines, could be tackled successfully by a dynamically competitive redesign of the PBM to State health plan marketplace. (As an example, please see the following blog post, To Address Drug Costs, Annapolis Should Look North to Trenton, published in Center Maryland by Americas Agendas Chief Economist Dr. Michael Kapsa: https://centermaryland.org/index.php?option=com_easyblog&view=entry&id=1702 .)3. Broadened Scope of Complimentary High Value Care Delivery Redesign and Implementation (i.e. improved medical claims data transparency, independent claims administration and adjudication, and expansion of high-value behavioral health services) - In Jan.-Feb. 2018, AAHCA was principal author, in partnership with the State of New Jersey and its State employees representative, of a proposal to CMS to expand the NJ Direct Primary Care Medical Home Program for New Jersey public employees and dependents to serve as a demonstration project for direct primary care as a foundation for a Medicare Demonstration Project piloting the advanced primary care delivery model as an effective cost-savings strategy applicable to both traditional Medicare and Medicare Advantage. Following this collaboration, AAHCA Executive Director Mark Blum was appointed by NJ Governor Murphy to represent AAHCA as a member of the NJ State Taskforce on Health Benefits Quality and Value. Throughout 2018, AAHCA worked with State administrative and legislative leaders, as well as with employee representatives and Taskforce representatives, to accomplish the State Taskforces mission of designing and implementing innovative improvements to public employee benefit design and care delivery that could serve, also, as incubators for high-value transformation of care delivery to all State residents. (Please s

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