Though ERISA is often thought of as an issue for retirement plans, the law has always applied to employer-sponsored health benefit plans. The Consolidated Appropriations Act of 2021 (CAA) sought to put a spotlight on the issue by clarifying responsibilities of health benefit plan fiduciaries and the third-party service providers they contract with. Yet, 3 years after its passage, many plan sponsors still can’t get their vendors or advisors to provide the required fee disclosures. 

“I’m baffled. I’ve never seen such wholesale noncompliance that seems to be just tolerated indefinitely. Something’s got to move there.” — Alden Bianchi

In this conversation with MTVA, attorneys Sarah Raaii and Alden Bianchi of McDermott, Will & Emery’s Employee Benefits & Executive Compensation Group share how to comply with the CAA’s new requirements, and what health plan fiduciaries can do to ensure they fulfill their responsibilities to beneficiaries. 

As attorneys who focus on health and welfare plan issues, Sarah and Alden discuss the history of ERISA, steps that employers and health plan fiduciaries should take, and what it might take to boost compliance. 

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Check out our other episodes on health plan fiduciary responsibility: 

All episodes of MTVA Unscripted can be found⁠ ⁠here⁠⁠.

“We have to cherish the opportunity in front of us. We’re at a point that public awareness of the current system failure is unprecedented.” 

American health care is in crisis, but this expert says there’s reason for hope. MTVA spoke with renowned scholar Ge Bai, PhD, CPA about the dynamics underlying problems in our system, and how middlemen keep taking a bigger piece of the pie. She makes the case for removing the confusing layers that separate patients and physicians. Placing power back in the hands of health care consumers will give providers and insurers a strong incentive to innovate – a much-needed course correction. 

Ge Bai is a Professor of Accounting at the Johns Hopkins Carey Business School and a Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. 

A leading voice in health care finance and policy, Professor Bai’s expansive expertise and extensive body of work is influential. In this episode, she shares insights gleaned from testifying before Congress and explains how to break through the bureaucratic gridlock in Washington, D.C. and transform our system. 

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We’re grateful to our Trade Member sponsor Connecticut Joint Replacement Surgeons LLC for their continued partnership and support of the Moving to Value Alliance.

We’re also excited to introduce the new MTVA Membership program! 

As a 501(c)(3) nonprofit, we rely on support from our grassroots network to advance our mission of creating a value-based health system with high-quality patient outcomes at a reasonable cost. We’re proud to offer two membership models, Ally Member and Trade Member. Tax-deductible membership contributions help us enrich the healthcare environment with quality content – including this podcast – and robust platforms to fuel discussion, collaboration, and advocacy that lead to ground-breaking solutions. 

For more information and to join us, visit our website www.movingtovalue.org/trademember.

All episodes of MTVA Unscripted can be found ⁠here⁠.

This episode is a must-listen for all plan sponsors and employers! 

“In American business you don’t expect your major vendors to be profit-gouging you, and you don’t expect these major consulting firms to be taking their side instead of yours.” – Paul Holmes 

As Pharmacy Benefit Managers (PBMs) face mounting scrutiny from policymakers and the public, health plan fiduciaries can’t ignore the money flows and potential conflicts-of-interest that may be hiding in the pharmacy benefit contracting process. 

In this episode, the MTVA Board talks with ERISA attorney Paul Holmes of Williams, Barber, Morel about the perverse incentives and lack of transparency in PBM contracts. Tune in to learn what plan sponsors need to ask their brokers and consultants and how to comply with new requirements in the Consolidated Appropriations Act (CAA). Holmes also discusses some innovative approaches – like carve-outs for specialty pharmacy and prior authorization – for plan sponsors to consider. 

This is the first episode in a new series from the “MTVA Unscripted” podcast called “PBM Problems” – exploring the middlemen who drive wasteful drug spending and pocket the profits. 

Resources mentioned in the episode:

All episodes of MTVA Unscripted can be found ⁠here⁠.

We’re grateful to Southern New England Healthcare Organization (SoNE Health) for their continued partnership and support as a sponsor of the Moving to Value Alliance. 
You can help advance our mission with a tax-deductible contribution at https://www.movingtovalue.org/jointhemovetovalue.

Join MTVA for a conversation with Dr. Scott Conard, MD, as we delve into the transformative power of purpose-driven healthcare. From fee-for-service models to data-driven initiatives, we explore improving healthcare outcomes, challenges in elder care, and the importance of a social model of care. Discover how autonomy, mastery, and purpose shape healthcare success and the need for a shift toward prevention and value-based care. Tune in for key insights and meaningful discussions shaping the healthcare landscape and learn how the power of purpose is driving change.

NOTE: MTVA encountered some technical issues with our audio early in the recording. You may notice some scratchy audio in the first few minutes, but the rest of the episode was not impacted. We apologize for this issue, and hope you still enjoy this conversation with Dr. Scott Conard as much as we did! 

Read more of Dr. Scott Conard’s work:

All episodes of MTVA Unscripted can be found ⁠here⁠.

In this episode, the MTVA team delves into the challenges and obstacles faced by a leading healthcare system in its transition into a patient-centered care model. Joined by Mount Sinai Health System's CMO and Senior VP of Population Health, Dr. Arshad Rahim, we discuss the complexities of aligning financial incentives with outcomes-based care principles, leveraging data-driven insights to drive behavioral change among providers, and reshaping patient care delivery through early-stage behavior modification. Most importantly, we explore the critical need for integrating population health and value-based care into medical education and residency training programs.

All episodes of MTVA Unscripted can be found ⁠here⁠.

The gig is up. Wake up and smell the coffee.

It’s finally happened. After years of speculating what an employee complaint against an employer for breach of fiduciary duty would look like, it has arrived. And this one doesn’t disappoint. Johnson & Johnson is being sued by its employees, alleging that their health plan overpaid for prescription drugs, costing workers money. This suit touches on ALL the many issues that we’ve been focusing on, including the fiduciary duty to act only in the best interest of plan beneficiaries, the adequacy of and potential bias involving the way health services are procured, agent/broker responsibilities and conflicts, the games that are played by PBMs to heavily markup drugs … and the glaring lack of diligence and accountability around these prices.  

This isn't just about one company's missteps — it's a wake-up call, folks. Countless similar cases are queuing up in its wake. It’s time to pay attention and it’s time to have a plan.

This episode features: 

Guest: Josh Golden, Senior Vice President, Strategy, Capital RX

Jeffrey Hogan, MTVA Founding Board Member & President, Upside Health Advisors

John Rodis, MD, President, MTVA and Founder and President, Arista Health, LLC

Lisa Trumble, MTVA Board Member & President and Chief Executive Officer, SoNE HEALTH 

Steve Schutzer, MD, MTVA Founding Board Member & Co-Founder, Upswing Health

All episodes of MTVA Unscripted can be found ⁠here⁠.

In the last episode of 2023, MTVA team leaders Jeff Hogan, John Rodis, MD, and Lisa Trumble dish out candid insights into the state of value-based healthcare and take a glimpse into 2024. They unpack the trend of primary care physicians shifting gears from employment to independence, delve into the pivotal role of employers in healthcare plan buying and management —hint: data analytics is STILL the key—and navigate a rollercoaster of complexities and strategies, seasoned with a dash of optimism for the year ahead!

This episode features:

All episodes of MTVA Unscripted can be found ⁠here⁠.

Buckle up, folks. Things are changing. We’re seeing influencers out there in the healthcare marketplace cause the behemoths to change their behaviors. We're also seeing some of the biggest companies in the country invest in solutions…to give better access to care, create predictability around outcomes, and get their data so they have better insight into their unique populations. Is it too early to celebrate the exponential curve?

All episodes of MTVA Unscripted can be found ⁠here⁠.

The MTVA team engages in a thought-provoking conversation with AJ Loiacono, CEO and Founder of Capital Rx, delving into the intricacies of pharmacy benefits and the challenges faced by employers in navigating the healthcare landscape. Loiacono provides insights into the complexities of drug pricing, the far-reaching effects of the Consolidated Appropriations Act (CAA), high-cost drugs, and the importance of data in optimizing valuable health plans. 

This episode features: 

All episodes of MTVA Unscripted can be found ⁠here⁠.

The MTVA team talks to Dr. James Caillouette, the visionary behind Hoag Orthopedic Institute, a joint venture orthopedic specialty hospital in Irvine, California, about the path to the establishment of a groundbreaking healthcare institution that prioritizes shared ownership and governance between hospitals and physicians. Jamie discusses the factors that drove the need for this innovative model, from the impact of the Affordable Care Act to the competitive landscape of Southern California. He gives us an inside look at the specialized surgical protocols and bundled payment offerings, highlighting the commitment to data-driven decision-making and the importance of maintaining a strong focus on patient experience, satisfaction, safety, and quality. 

This episode features: 

All episodes of MTVA Unscripted can be found ⁠here⁠.