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New leader of employer health group talks drug costs and improving access to mental health care

Star Tribune - 12/14/2019

Health care costs keep growing and employers see it front-and-center. In September, the California-based Kaiser Family Foundation reported that the average cost of family coverage in employer health plans now exceeds $20,000. The concerns have prompted some employers to consider cutting out middlemen by contracting for services directly with health care providers. It is a trend not lost on Mamie Segall, a longtime health care executive named this month as president of the Bloomington-based Minnesota Health Action Group. The organization developed an innovative plan called Choice Plus in the 1990s that allowed large employers to pool their purchasing power when buying health insurance. Segall wonders if something similar might work with drug coverage.

Q: You are originally from Wisconsin and went to law school in Boston. What brought you to the Twin Cities?

A: I moved to Minnesota to go to work for Attorney General Skip Humphrey. … In the AG’s office, I spent seven years prosecuting white collar health care fraud, also abuse and neglect of vulnerable adults. Toward the end of my tenure in the AG’s office, I led health policy initiatives.

Q: You moved to the private sector in the 1990s by working at Diversified Pharmaceutical Services, which started as the pharmaceutical benefits manager (PBM) for UnitedHealthcare -- is that right?

A: I was their first legal compliance officer when the company was owned by SmithKline Beecham, an international pharmaceutical company. So, I got to learn a lot about PBM operations, the law, the science, the policy. I found it fascinating then, and I still do. The complexity and the importance of the drug benefit I think just continues to grow.

Q: The Minnesota Health Action Group represents large employers in the state that operate health plans for workers. What are employers’ biggest concerns right now when it comes to health care?

A: I think that employers’ biggest concerns ... are [first] affordability, broadly. No. 2 is mental health, broadly, and workplace mental health, specifically. And lastly, specialty drugs in specific, and pharmacy more generally. As we’ve had an explosion in opportunity and new therapies, critical therapies, we also have the challenge of figuring out how to pay for those therapies.

Q: How might the group respond?

A: I believe that the action group, in a variety of ways, addresses all of those issues, through a framework of sharing information, wielding best practices through that exchange and then driving action based on those best practices.

Q: Specialty pharmaceuticals refer to a subset of high-cost medications. Any specifics on how employers might push for savings?

A: It’s a big driver, and escalating driver, of health care costs. It makes it difficult to have affordable benefits. So, the action group’s most recent work to create the specialty drug playbook and help employers get smarter about how to buy pharmacy … I think continuing and amplifying those efforts will be key. ... This is going to be one of my challenges: figuring out ways to make it even more actionable. How do we bring the collective power of purchasers together more effectively? ... [Can we start to] develop some solutions, similar maybe in some ways to what the action group did 30 years ago with Choice Plus?

Q: Do you mean some sort of collective approach to pharmacy benefits that spans employers?

A: That is what I want to explore. With pharmacy in specific, I think there is a spectrum of opportunity from ... really driving best practices and knowledge, helping to continue to demystify, all the way to ... figuring out a way to do an independent collective purchase that can help the employers in Minnesota and those purchasers to truly get the best value. That would be a big challenge, but I definitely want to take it on.

Q: Were you involved with Choice Plus in the 1990s?

A: It was not directly in my work scope, but I have a vivid memory of how disruptive it was. At the time, it was disruptive and it was threatening to traditional insurers and health plans. It was the classic disintermediation -- we’re not going to need you, we can go direct. That was disruptive and motivating -- those kinds of changes motivate traditional players to do better.

Q: The Minnesota Health Action Group’s push for better mental health care treatment and coverage was backed this year by a federal grant from the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit group authorized by Congress in 2010. What’s next for this effort?

A: The action group has been a leader in the most recent Mental Health Guiding Coalition. The work has been recognized with the PCORI grant that will permit us to accelerate efforts across the state. … [Last week] we were selected as one of a number of coalitions for the national Path Forward RESET Regions grant. So, we will have the opportunity over the next five years to dig deeper to improving access to in-network behavioral health, expanding collaborative care, working on mental health parity -- all of the things that had been in cue, but we are going to have the capacity to do even more.

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