Chair: Bonnie Phipps, CPA, FHFMA, Senior Consultant, Yaffe & Company
Staff: Brian Levine, 410-727-2820
Description: The Health Care Committee’s focus is to foster health-conscious workplaces within the Greater Baltimore region by educating members on emerging health concerns. In addition, the committee monitors federal and state health care policy, and its impact on the cost of doing business and business operations.
Membership: Membership in the Health Care Committee is open to all GBC members.
Activities:
2018 Health Care Committee news:
Jeff Beeson, Deputy Director of Management Coordination for the Washington/Baltimore High Intensity Drug Trafficking Areas (HIDTA), discussed the role of his organization at the GBC Health Care Committee’s September 18, 2018 meeting.
HIDTA works to disrupt the market for illegal drugs in the United States by assisting federal, state and local entities participating to dismantle and disrupt drug trafficking organizations, with particular emphasis on drug trafficking regions that have harmful effects on other parts of the United States. There are currently 28 HIDTAs, including the Baltimore/Washington region. Beeson said that the Washington/Baltimore HIDTA is unique because Baltimore City originally was deemed a drug use area, not just a drug trafficking area. Today, there is an increase in lethal drugs on the streets, most notably fentanyl, an opioid often made illegally and mixed with heroin.
In Maryland, fentanyl overdose deaths surpassed heroin overdoses in 2016 for the first time. Beeson said that in order to combat this epidemic, which should be treated as a health crises, leaders must address increased use fentanyl, lack of real time data, insufficient information sharing and little to no consensus on what constitutes a spike in the abuse of drugs.
HIDTA has developed a case management system that can be used to share information with other states and jurisdictions to help fight addiction and stop trafficking. It is important to tackle the issue of opioid abuse as a health crises as well as a business issue.
The GBC Health Care Committee continued discussions at its July 10, 2018 meeting about a guide for employers which is meant to help businesses address opioid-related issues in the workplace and help to prevent addiction before it happens.
The Greater Baltimore Committee’s Health Care Committee’s May 15, 2018 meeting featured three presenters discussing a variety of health care issues that can affect the workplace.
Mark O’Brien, Vice President of State and Local Affairs for the Addiction Policy Forum, discussed his organization’s efforts to combat drug and alcohol dependency. The organization’s priorities to fight addiction include helping families in crises, expanding treatment, driving discovery, expanding recovery support, preventing addiction, protecting impacted children, reframing criminal justice and providing advocacy and education. More than 21 million Americans are suffering from substance use disorders.
Bonnie Phipps, Chair of the GBC Health Care Committee, provided an update on efforts to combat opioid abuse. First, Phipps updated the Health Care Committee on recommendations developed and presented to the Baltimore City Health Department’s Fentanyl Task Force’s regarding opioid-related insurance policies, which included best practices for prevention and treatment. She also discussed various strategies employers can use to address opioid-related issues in the workplace.
The next presentation was about the work of the Alzheimer’s Association and the impact of the disease. The discussion was led by the Alzheimer’s Association’s Greater Maryland Chapter Executive Director Cass Naugle and Development Director Ellen Torres. In 2017, more than 5.5 million Americans had Alzheimer’s dementia, making the disease a national health crises. Public policy goals in Maryland include supporting prevention and early identification, enhancing the quality of care, enhancing public awareness and improving data capacity to track progress.
The GBC Health Care Committee learned at its March 19, 2018 meeting about how federal tax law changes affect nonprofit organizations.
The presentation was delivered by KPMG’s Nancy Murphy, Principal, Exempt Organizations, and Preston Quesenberry, Managing Director, Exempt Organizations. Murphy began with an explanation about how the U.S. Congress debated and passed the Tax Cuts and Jobs Act and then discussed how the tax package impacts a wide range of activities, including the corporate tax rate, the Alternative Minimum Tax, net operating losses, lobbying expenses, charitable donations and tuition-paying students.
With regards to nonprofits, Murphy and Quesenberry focused their presentation on the law’s effect on unrelated business taxable income provisions, colleges and universities and excise taxes on excess compensation.
2017 Health Care Committee news:
Chet Burrell, President and CEO of CareFirst BlueCross BlueShield, delivered a presentation at the Health Care Committee’s November 7, 2017 meeting highlighting the current state of health care and CareFirst’s operations.
Overall, health care premiums are up more than 200 percent since 1999, although workers’ earning are up only 64 percent and inflation 47 percent. Out of pocket costs alone have risen nearly 16 percent since 2014. Due to rising costs, employers with fewer than 50 employees are choosing to introduce high deductible plans or dropping coverage. One of the reasons for rising costs is the consolidation of providers into bigger systems. Consolidation does not produce economies of scale in health care. Another driver is pharmacy costs.
Burrell also addressed addiction and opioid abuse. More people died in 2016 from drug overdose than during the Vietnam War, he said. CareFirst has actively monitored this issue and implemented a strategy to combat the national problem. Most significantly, CareFirst has limited opioid prescriptions to seven days and limited the dosage prescribed. The health care provider has also found ways to waive certain fees and follow up with individuals after they have been in treatment for up to one year to increase their likelihood of success.
Gene Ransom, CEO of MedChiGene Ransom, CEO of MedChi, delivered a presentation at the committee’s October 17, 2017 meeting, highlighting top issues for physicians. Founded in 1789, MedChi is the medical society for the State of Maryland representing the interests of physicians and enhancing healthcare for all Marylanders.
Many changes are taking place the within health care industry and Maryland is currently experiencing major changes to its health care financing model. Ransom explained that MedChi is a resource and can assist with new regulations and changes. The MedChi House of Delegates debates policy positions at bi-annual meetings that sets the organizations policy and guides its advocacy efforts. The group is actively defending the interests of physicians on medical liability including filing amicus briefs for landmark cases. Most importantly, it operates the Maryland Physician Health Program, which is a voluntary and confidential resource where medical professionals may seek help with mental health, behavioral, or addiction issues.
Health Care Committee Chair Bonnie Phipps introduced the presenters for the July 24, 2017 meeting: Mark O’Brien, Director of Opioid Overdose Prevention and Treatment for the Baltimore City Health Department (BCHD); Evan Behrle, Special Assistant to the Health Commissioner for the BCHD; and David McShea, Executive Director of the American Diabetes Association (ADA), Maryland Chapter.
O’Brian and Behrle focused on the opioid epidemic in Baltimore City while McShea discussed the ADA’s upcoming Step Out: Walk to Stop Diabetes event in October.
Behrle began with an overview of the BCHD. The agency was founded in 1793, making it the oldest health department in the country. BCHD’s funding structure is unique compared to other city agencies because 80 percent of its funding comes from grants while the remaining 20 percent is contributed by the city. This formula allows for BCHD to be nimble and respond quickly to the health disparities currently plaguing the city. For example, 20 years ago BCHD created one of the first needle exchange programs in the country. Although controversial at its conception, the program was instrumental in reducing HIV transmission rates in city. The same program is now being employed in the fight against opioids.
O’Brien reviewed the data regarding Maryland’s opioid deaths. Since 2012, the number of overdose deaths nearly tripled. In Baltimore City, overdose deaths have risen from 225 to 694 in the same time period. The increase in the number of deaths is attributed to Fentanyl — a cheaper, synthetic opioid that is more potent than morphine and heroin. For the first time in 2016, fentanyl and heroin deaths reached a parity.
BCHD currently implements an aggressive multifaceted approach to fighting opioids: Use of the drug Naloxne, public education and access to treatment. Naloxne is a powerful antidote used to reverse opioid overdoses and is available as a nasal spray or a needle injector. It takes only a few minutes to learn how to administer the drug. To date, BCHD has distributed more than 21,000 kits of the antidote to city residents, saving more than 1,000 lives.
When it comes to public education, BCHD runs the “Don’t Die Campaign” which focuses on the dangers of opioids and opportunities to learn about how to effectively use Naloxone. The campaign utilizes bus stops, busses, billboards, metro stations and libraries in the city. Regarding access to treatment, BCHD utilizes a buprenorphine expansion plan and hosts a work group that meets monthly on treatment access and neighborhood relations.
Switching gears, the committee heard from McShea who provided an overview of the ADA, whose mission is to find a cure for diabetes and improve the lives of those living with the disease. Every year, 1 million new individuals are diagnosed with diabetes. Currently, more than 600,000 individuals – or 12 percent of Maryland’s population – has diabetes. The disease is an underlying cause for many deaths each year despite going unreported on the death certificate.
The ADA hosts two primary walks in Maryland. The first walk will take place on October 1 at the Canton Waterfront Park in Baltimore and the second will be held on October 8 at Baker Park in Frederick. GBC members that achieve fundraising goals will be rewarded with various prizes and benefits including a “Lunch and Learn” presentation provided by the ADA and six month family membership to The Y in Central Maryland. This year GBC members will participate in the walk as an umbrella team — Team GBC.
At the Health Care Committee’s May 16, 2017 meeting, committee members heard from Carmela Coyle, President and CEO of the Maryland Hospital Association (MHA). She focused on the 2017 legislative session of the Maryland General Assembly from a health care perspective.
Coyle discussed the MHA’s three priorities during the session. The first was the Medicaid tax on hospital care which was initiated by former Maryland Governor Martin O’ Malley in 2009, which grew from $19 million to $365 million in 2016. The tax was meant to help curb the impact of the 2008 economic recession. Currently, the tax adds approximately 2.3 percent to every hospital bill in the state. It also artificially inflates spending costs which negatively impacts Maryland’s federal waiver since the state has agreed to stay below a certain spending threshold.
The next priority was liability costs. Maryland has one of the most challenging environments in the nation with regards to malpractice lawsuits. Currently, the cap for non-economic related damages is $785,000 and there is no limit for compensation for economic damages. Maryland ranks ninth in the nation for medical malpractice payouts per capita and Coyle believes the funding could be allocated for health care.
The third priority was behavioral health, a popular issue which resulted in an overwhelming number of bills filed related to the topic. Coyle highlighted three specific behavioral health bills: Keep the Door Open Act, HOPE and Treatment Act and Prescriber Limits Act.
Don Fry, President and CEO of the GBC, presented the outgoing Health Care Committee Chairman Albert “Skip” Counselman with a gift and thanked him for his tenure at the committee’s February 6, 2017 meeting. Counselman is succeeded by Bonnie Phipps.
Patrick Redmon, Director of Berkley Research Group, presented at the committee meeting about transformative changes to the health care delivery model. Redmon has more than 20 years of health care economics experience and was the former head of the Health Services Cost Review Commission.
Redmon began by discussing national health care trends. In 2014, health care expenditures accounted for 17.5 percent – or $3 trillion – of Gross Domestic Product (GDP) in the United States. These costs are projected to reach 20.1 percent of GDP by 2025. The upward trend is the result of an aging population.
He then focused on a review of Maryland’s payment model. Maryland has had a federal waiver from Medicare since 1977 which stems from provisions in the Social Security Act which allowed the state to set its own rates for all-payers. Maryland is the only state to continue the practice of Medicare, Medicaid and commercial payers all paying the same rate for a unit of service. Redmon mentioned that the longevity of Maryland’s payment system is due to its flexibility and the general consensus around great regulation in the state.
Now Maryland’s all-payer model has shifted from being volume based to population oriented. The model includes two phases: Phase I began in 2014 and will run through 2018 and focus primarily on removing substantial hospital spending from the economy. Phase II is slated for implementation in 2019 and will focus on Total Cost of Care over the course of five years.