Morgan Health: Improving Employer-Sponsored Health Care Requires Federal Policymakers to Prioritize Value-Based Reforms

Lagging adoption of accountable care in employer-sponsored insurance requires federal action

Recommended policy reforms provide roadmap for bipartisan collaboration to address data, workforce challenges

WASHINGTON, D.C., June 8, 2023 – To improve health care for 160 million Americans with employer-sponsored insurance (ESI), Morgan Health urges federal policymakers to prioritize reforms that advance and help scale accountable care within the country’s largest insurance sector. Given the lagging adoption of accountable care in ESI relative to Medicare and Medicaid, Congress and the Biden-Harris Administration can support bipartisan solutions designed to enhance data sharing, strengthen the health care workforce, and as a result, meaningfully accelerate accountable care initiatives among employers.

“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. “While employers have made meaningful strides to deliver innovative care and benefits to employees, there are long-standing barriers that require Congress and the federal government to act in tandem with the private sector.”

Under fee-for-service payment models, providers and specialists are paid based on the volume of care provided, not improvements to patients’ health. According to the latest market data, fewer than 13 percent of commercial insurance payments in 2021 were tied to two-sided financial risk for improvements in health outcomes, compared to more than 35 percent of payments in Medicare Advantage and 24 percent in traditional Medicare. These perverse incentives undermine employers’ ability to offer accessible, high-quality primary and accountable care programs, and ultimately contribute to pervasive gaps in health outcomes among employees.

Since its launch in 2021, Morgan Health, a JPMorgan Chase business unit located in Washington, D.C., has focused on improving the quality, affordability and equity of employer-sponsored health care for JPMorgan Chase employees and the millions of Americans who receive coverage through their work. Through its efforts to invest in, scale and implement new accountable care models, Morgan Health has identified bipartisan solutions that will speed the adoption of these innovative care models while improving access to mental and behavioral health services for those with ESI. Those recommendations include: 

• Advancing data quality and uniformity standards across the health care system.
• Addressing workforce shortages in primary and behavioral health.

“Employee health issues are often categorized as being out of reach given ERISA regulations, and as a result, many workers and their families contend with an antiquated health system that doesn’t prioritize quality, affordability or equity,” Orriel Richardson, Vice President of Health Equity and Policy, said. “These solutions represent the fundamental building blocks of a health system that is accountable for health improvement and equitable care for an increasingly diverse workforce.”

Advancing data quality and uniformity standards 

Health care payment, delivery and quality depend on clean, consistent data. Yet, barriers facing employers, health plans and providers continue to hinder meaningful data collection, use and reporting.

Federal policymakers can address these barriers by:

• Finalizing a recent proposal around the creation of a centralized, national provider directory. In a recent letter to CMS Administrator Chiquita Brooks-LaSure, Mendelson noted that a national provider directory would support efforts to provide a “more accurate picture of where individuals are seeking care, helping to inform benefit design refinements and network improvements needed to optimize access to and quality of care delivered to members across geographies and specialties.”
• Modernizing the existing HIPAA statute to better reflect current technological and business transactions so that providers, health plans and third-party administrators can communicate safely, effectively and in real-time around care delivery.
• Providing consistent standards for race/ethnicity data collection, use and reporting that are aligned between the private sector and federal government, building on the forthcoming update from the Administration to federal data and reporting requirements.

Addressing workforce shortages in primary and behavioral health

In the aftermath of the COVID-19 pandemic, Congress has rightly sought out ways to bolster and strengthen the health care workforce amid widespread burnout among providers and growing recognition around the need for greater diversity and representation among clinicians. As part of JPMorgan Chase’s commitment to improving the health of the communities it serves, the firm has invested in job skills and training programs specifically focused on addressing gaps in local health care delivery systems.

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, policymakers should prioritize the following:

• Encouraging accountable care arrangements that promote primary care with full integration of primary behavioral health care. In models where there was full integration of primary and behavioral health care, the number of patients who receive behavioral health services increased alongside a reduction in the total cost of care.
• While scope of practice laws are regulated at the state level, where federal policymakers can empower non-physicians’ ability to practice to the top of their licenses and improve reimbursement for behavioral health care services would yield greater availability of behavioral health care services.

For additional details on the proposed reforms, click here.

About JPMorgan Chase

J.P. Morgan is a global leader in financial services, offering solutions to the world's most important corporations, governments and institutions in more than 100 countries. We also lead volunteer service activities for employees in local communities by utilizing our many resources, including those that stem from access to capital, economies of scale, global reach and expertise.

About Morgan Health

Morgan Health is a JPMorgan Chase business unit focused on improving employer-sponsored health care. Through its investments and the advancement of accountable care, Morgan Health is working to improve the quality, equity and affordability of employer-sponsored health care for JPMorgan Chase employees, their families and the U.S. health system. The business is led by Dan Mendelson, CEO of Morgan Health, reporting to Peter Scher, Vice Chairman of JPMorgan Chase & Co. and a member of the firm’s Operating Committee. Morgan Health is headquartered in Washington, D.C. Visit www.morganhealth.com.