In January, ESI was the first PBM to select a preferred medication for the treatment of genotype 1 Hepatitis C, resulting in a significant decrease in treatment cost for PMI members and opening the way for savings opportunities for all Americans. In July, the Food and Drug Administration (FDA) approved a new class of high-cost cholesterol medications, PCSK9s. Informed on issues of value, clinical-effectiveness, and likely FDA actions, PMI members had policies in place to ensure appropriate access to the medications the day they became available. The BHC appreciates the dedication of the ESI team and Dr. Steve Miller, Senior Vice President, Chief Medical Officer, for keeping members informed of the changing pharmaceutical landscape.

Founded in 1982, the St. Louis Area Business Health Coalition (BHC) is an employer-led, non-profit organization focused solely on health care. The BHC serves as a trusted source of information, networking, and resources for its public and private sector members. Together, the BHC members work to gain greater value for their investments in health care and improve the well-being of their workforces, families, and communities. The BHC is honored to represent the region’s leading employers in their pursuit of better quality, safer, and more affordable health care.

Intensifying the Focus on Value Specialty medications represent less than 1% of all prescriptions yet account for more than 30% of all drug costs, and these costs are growing. Increases in specialty drug spending led overall pharmacy trend to double-digit growth last year for the first time in over a decade.

The BHC’s Pharmacy Management Initiative (PMI), in partnership with pharmacy benefits manager (PBM) Express Scripts (ESI), is taking bold steps to limit costs while improving care. In 2016, the PMI will have 39 participating employers representing 300,000 lives. The BHC and ESI work collaboratively to support employers in developing benefit designs and formularies to match their organizational goals. Through regular educational sessions and dialogue with fellow members, PMI users gain insights which shape strategies to ensure access to life-altering medications while reducing spending on lower-value products.

“I appreciate the opportunities to connect with my peers and the support received from the BHC.”

Lisa Roseland, Manager, Health & Life Benefits, Ameren

Connecting Members to Peers and OpportunitiesIn 2015 the BHC afforded members over 40 opportunities to share best practices, stay informed, and learn from peer professionals and the experts. The Affordable Care Act (ACA) continued to be a focus as BHC members unraveled regulation details including the Cadillac Tax, final reporting forms, and pay or play rules.

The BHC’s Data Roundtable celebrated its second year with members choosing to focus on musculoskeletal disorders (MSDs). In addition to reviewing common clinical diagnoses, procedures, and pharmaceutical costs under the MSD bucket, a coding booklet was produced to assist members in deciphering claims data and initiating meaningful conversations with their health plans and data vendors.

The BHC hosted two community conversations to better understand the current challenges, thoughts, and opportunities that affect cancer care in St. Louis. The meeting engaged health care professionals, employers, payers, and community members. Discussion topics included emerging technologies, their high cost, and ways to structure benefits to ensure patients’ long-term access to truly life-altering medications.

“The BHC is a valuable resource to keep me up to speed on the most important health care topics.”

Jennifer Schaefer, Director, Global Benefits, Sigma-Aldrich

Keynote Speaker Dr. James Reinertsen reminded us that we all have choices and that the decisions we make shape our health care system.

He also passed along the research of Dr. Amy Cuddy, who found something as simple as a brief "power pose" can transform thoughts and outcomes.

"Leaders, or Victims? Choices We Face on the Path to Accountability"

A change observed in the analysis was employers providing greater attention to wellness. Monsanto Company, winner of the 2014 BHC Business Health Culture Award, provided further insight into the benefits of adopting a broad approach to employee well-being. Monsanto team members spoke at several BHC and community events on the positive impact of strategies to improve the financial, emotional, and social health of a workforce.

The BHC conducted a pre- and post-ACA comparative analysis of benefit plan designs and evaluated changes in premiums, cost-sharing, incentives and surcharges. This allows members to better understand trends and how their benefits compare to peer organizations. The analysis was

based on data collected from 58 member companies across 311 separate health plan offerings.

In support of its commitment to total well-being, the BHC was awarded a grant to assist members in raising awareness surrounding mental illness in the workplace using the Right Direction program. Together with the Missouri Department of Mental Health, the BHC hosted a Mental Health First Aid training. Twenty-five company representatives learned skills for identifying and assisting individuals experiencing common mental health conditions.

The Midwest Health Initiative (MHI) began sharing its data set with the community to improve care quality and affordability. MHI continued a multi-stakeholder dialogue supported by new information on variation in the cost of care. MHI hosted a Community Conversation on September 11 bringing together about 80 area health care and employer leaders to view MHI data and data from publicly- available data sets. Attendees began a dialogue about whether a community scorecard might support our region in defining and tracking its progress toward improving quality of care and affordability. Further, some health care provider organizations are licensing the data set and using it to better understand the quality of care they provide compared to their peers and to inform their quality improvement efforts.

Sharing Information to Inspire Advocacy and Action In 2015, the St. Louis Health Care Industry Overview provided expanded information on health care value in the region. The Health Plan report highlighted how aligned incentives in Medicare Advantage plans may be driving better quality of care to members as compared to enrollees in commercial plans. This may offer important lessons in “accountable care.” For the first time, quality scores for private physicians participating in accountable care organizations were included in the Outpatient Care report.

Mental Health First Aid Training

“We are committed to supporting our associates in navigating the often challenging and fragmented health care system. Our concierge service vendor enables our employees and their families to better understand cost and quality information and allows them to make more appropriate health care decisions.”

Ed Strouth, Director, Health & Wellbeing, Barry-Wehmiller Companies

2015 BHC BOARD OF DIRECTORS Kevin SuppleChief Financial Officer, Francis Howell School District

Tim SutterDirector, Compensation and Benefits, Caleres

David TobenDirector of Benefits, Bi-State Development/Metro

John ZieglerChief Commercial Officer, Arch Coal, Inc.

Ex-Officio MembersBob KnowlesRetired, Health & Welfare Benefits Lead, Monsanto Company

Bob WaldRetired, Director of Benefits, Smurfit-Stone

Bold text denotes Executive Committee Member

Beth Biggs Vice President, Benefits, Charter Communications

Sandi Boller Vice President, Human Resources, US Bank

Dolores Ennico Vice President, Human Resources, Olin Corporation

Judy FairesDirector, Welfare Plans, Corporate Benefits, Emerson

Gail Frye Senior Director, Compensation and Benefits, Panera, LLC Debbie Hanlon Vice President, Human Resources, ESCO Technologies

Bruce HansonSenior Manager, Union Pay and Benefits, The Boeing Company

Rick KusnierzDirector, Global Benefits, Peabody Energy

Marla LangenhorstDirector, Benefits & HR Technology, Ameren

Joan Lawrence Director of Health & Welfare, Anheuser-Busch InBev

Kirk McCarleyDirector of Personnel, St. Louis County Government

Carolyn PlummerHealth & Welfare Benefits Lead, Monsanto Company

Kristine SchusterVice President, Human Resources, Mississippi Lime Company

Ed StrouthDirector, Health & Wellbeing, Barry-Wehmiller Companies, Inc.

Carrying the Torch: The BHC Welcomes New LeadersThe BHC has flourished under the leadership of Ed Strouth, Barry-Wehmiller Companies, Inc. as Board Chair for the past two years. In 2016, the BHC will welcome Carolyn Plummer, Monsanto Company, as Board Chair and Tim J. Sutter, Caleres, as Vice-Chair. Kevin Supple, Francis Howell School District, and Rick Kusnierz, Peabody Engery, have joined the Executive Committee. Kevin will bring his financial expertise as Treasurer. The BHC welcomes the following new members to its 2016 Board of Directors:

In the spring, MHI shared insights from its data set with the region’s largest physician groups on the total

cost of the care provided to their patients and how it compares to benchmarks. The groups also received comparative quality and utilization information. Over the summer, MHI introduced CareWell, an online portal for physicians to give them the opportunity to better understand how often their patients receive care in line with nationally-standardized measures and compared to benchmarks. Next summer, MHI will launch a public website with comparative quality information.

Joan Lawrence, Anheuser-Busch InBev

Gail Frye, Panera, LLC

The BHC appreciates the contribution of all of its Board and Executive Committee members. Special thanks goes to Sandi Boller, Vice President, HR, US Bank, and Jeff White, Director of Healthcare Policy & Strategy, The Boeing Company, for their years of service.

8888 Ladue Road, Suite 250St. Louis, MO 63124

314-721-7800www.stlbhc.org

AAF International Aegion CorporationAmeren CorporationAnheuser-Busch InBevArch Coal, Inc.Barry-Wehmiller CompaniesBass Pro Shops, Inc.Bi-State Development/MetroThe Boeing Company Bunzl Distribution USA, Inc.CaleresCharter CommunicationsCity of St. LouisConcordia Plan ServicesCushman & Wakefield Daikin Applied The Doe Run Company Drury Hotels CompanyEdward JonesEmersonEmmaus HomesEnergizer Holdings, Inc.

ESCO Technologies, Inc. Ferguson-Florissant School District Francis Howell School DistrictGlobal Brass and Copper, Inc.Graybar Electric Company, Inc.Laclede Gas CompanyLaird Technologies, Inc.Maines Paper & Food Service, Inc.McCarthy Holdings, Inc.Mississippi Lime CompanyMonsanto CompanyNorthwest R-I School DistrictOlin CorporationPanera, LLCParkway School DistrictPeabody EnergyRockwood School DistrictSaint Louis Public SchoolsSchnuck Markets, Inc.Shelter InsuranceSigma-Aldrich Corporation St. Louis County

St. Louis Graphic Arts Suddenlink CommunicationsTheBANK of EdwardsvilleTucson Electric Power US BankWatlow WestRock Co.World Wide Technology, Inc.

HEALTH CARE HR PARTNERS:Mallinckrodt PharmaceuticalsSaint Louis UniversityUniversity of Missouri

SUSTAINING MEMBERS:Aon HewittLockton Companies, LLCMercerTowers Watson & Co.

MEMBERS:

BHC STAFFLouise Probst Executive Director

Mary Jo Condon Senior Director, Partnerships & Projects

Deena Fischer Senior Director, Communications

Melissa Hogan Senior Director, Health Improvement & Member Services

Todd Boedeker Member Services Coordinator

Dave Heaton Product Manager

Addison HendrixOffice Coordinator

Kara Hoerth Medical Records Abstractor

Karen RothDirector of Research

Lauren Schulte Senior Manager of Wellness Services

Ruth Stewart Executive Assistant/Board Secretary

Melanie WatsonOperations Manager

The BHC’s membership growth has continued during 2015. BHC welcomes its newest members: AAF International, Daikin Applied, Northwest R-I School District, and Saint Louis University.