PBGH Issues Purchaser Policy Priorities Brief

As the newly-elected 119^th Congress readies to tackle a list of legislative priorities, PBGH has identified and built consensus around a set of health policy priorities for 2025 that will lower costs, increase transparency, raise the quality of care for patients, and bring much-needed accountability to the health care system.

The health care affordability crisis continues to worsen. Health care market consolidation has led to skyrocketing health care prices and spending. This problem is compounded by a lack of price and quality transparency, which affects purchasers’ ability to provide affordable, high quality health care to employees and their families and fulfill their fiduciary duties.

Against this backdrop, PBGH and its members remain committed to containing unrelenting health care cost growth that imposes an intolerable financial burden on patients and businesses, while improving care quality and access to optimize employee health. Under new legislative and regulatory pressures and newly elevated fiduciary responsibilities, large purchasers are changing procurement strategies to better ensure high quality and fairly priced care, while also engaging in policy to create a functional health care market.

To improve affordability, the Issue Brief identifies specific policy actions for Congress and the Administration, including:

• Lower Health Care Costs by addressing hospital and drug pricing, limiting consolidation, and prohibiting anti-competitive practices.
• Improve Data Access and Transparency by enforcing hospital price transparency and transparency in coverage regulations and enhancing penalties for non-compliance.
• Enact Service Provider Reforms by ensuring PBM and TPA transparency, including reporting drug pricing data and prohibiting gag clauses, and extending fiduciary obligations to service providers.
• Support Direct Contracting and Joint Purchasing by clarifying antitrust guidance allowing multiple employers to join together, and ensuring direct contracts are covered by ERISA’s preemption law.

Many of these policy recommendations are important to enable employers’ ability to meet their fiduciary responsibilities on behalf of employees and families.

In addition to affordability, the Brief offers recommendations on improving access to needed high-quality care. PBGH supports efforts to:

• Improve Maternal and Child Health ensuring access to safe and high quality maternal and post-partum care – especially in rural areas- through a whole person approach and expanding access to care teams including midwives and doulas.
• Improve Primary Care and Mental Health by removing barriers to advanced primary care, investing in the primary care workforce, and integrating mental health care into primary care.

Read the full Issue Brief on Purchaser Policy Priorities in 2025 here.