
- Provide a forum for innovative benefit leaders, health plans and select industry partners for health care cost and delivery-focused discussions and to inform their decision-making process;
- Evaluate specific issues that are important for controlling costs, improving quality and access and adopting value-based care and payment models;
- Identify, analyze and evaluate the most promising practical solutions to the health care cost crisis relevant to self-insured employers;
- Inform development of alternative approaches and the business case for these alternatives, along with analysis of solutions, including how to pay for the explosion of new technologies;
- Keep members on the leading edge of innovation and health care transformation;
- Identify emerging strategic and structural changes in the health care delivery system that potentially will change the health care cost/value equation in the long term and how these changes may re-define the role of employers;
- Influence the agenda of Business Group conferences and publication topics to showcase emerging trends and generate actionable insights for members; and
- Monitor developments in health care policy, share timely insights and identify the potential impact of changes on employers.
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Cost & Delivery Institute
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Cost & Delivery Institute
Scope of Work
Cost & Delivery Institute
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The Cost & Delivery Institute creates a forum for health care cost- and delivery-focused discussions and contributes to the resources created by the Business Group.
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Previous and future agenda topics for conferences include:
- 1 | High-cost conditions and clinical innovation
- 2 | Value-based care models
- 3 | Innovation in plan design
- 4 | Data transparency and interoperability
- 5 | Consumer-directed health plans and the evolving role of consumerism
- 6 | Navigating members to appropriate care
- 7 | Cost of specialty medications
- 8 | Drug coverage under the medical plan
- 9 | Behavioral health access and delivery challenges
- 10 | Virtual care
- 11 | Health care quality and access
- 12 | Precision medicine, including genetic testing and gene therapy
- 13 | Women’s health
- 14 | Oncology payment models
- 15 | Health policy and macroeconomic challenges impacting health care consumption

- Creating a forum for employers, physicians, health plans, consumers and research and policy experts to advance a new framework for health care based on medical evidence;
- Identifying gaps between the care that the best medical evidence suggests patients should receive and what employers are incentivizing, covering, and communicating to employees in practice;
- Translating evidence assessments into recommendations for plan design elements and employee supports to reduce misuse and overuse of health care and direct spending to high-value services;
- Developing employee communications that encourage sound decision-making;
- Promoting primary care and health information exchange (HIE) reforms;
- Enabling employers to promote shared decision-making, thereby empowering their members to become active and informed participants in their health journey;
- Identifying quality and meaningful measures of physician performance;
- Evaluating emerging payment models and plan design innovations aimed at improving care quality and efficiency; and
- Reducing misuse and overuse of health care and re-directing spending toward high-value services.
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Evidence-based Benefit Design Committee
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Evidence-based Benefit Design Committee
Scope of Work
Evidence-based Benefit Design Committee
The Evidence-Based Benefit Design Committee helps identify emerging health care benefit design topics and contributes to the resources created by the Business Group. The committee members collaborate through:
- Semi-annual in person meetings with agenda items including employer roundtables; presentations from industry experts and innovators, benchmarking and networking;
- Additional virtual meetings scheduled throughout the calendar year to feature emerging evidence-based topic and member discussion; and
- Publication of resources on emerging topics covering plan design studies, benchmarking, and health conditions that are cost drivers for self-insured members.

- Create a community of like-minded peers to learn from and support on trending pharmaceutical issues and everyday challenges;
- Explore and harness a diversity of perspectives represented by colleagues across many aspects of the pharmaceutical supply chain (e.g., pharmacy benefit managers, health plans, pharmaceutical manufacturers, genetic testing companies);
- Leverage best practices for optimizing value in pharmaceutical benefits and zeroing in on total cost of care with access to thought leadership from industry and policy experts;
- Remain on the leading edge of industry innovation, closely following the specialty pipeline and groundbreaking advancements in precision medicine;
- Explore and support the linkages between drug adherence, health and productivity;
- Build an agenda for discussion topics, committee resources and products based on timely and relevant member priorities; and
- Provide a channel for confidential sharing of ideas and experiences among PBC members.
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Pharmacy Benefit Committee
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Pharmacy Benefit Committee
Scope of Work
Pharmacy Benefit Committee
The PBC helps drive the pharmacy resources for the Business Group and provides an active member engagement platform. The full committee meets three times each year. Two meetings are held at the Business Group offices in Washington, D.C., and one takes place online via teleconference. In-person meetings dedicate six hours to business; teleconferences last approximately two hours. Minutes of each meeting are kept and distributed to all members of the Committee. In- between meetings, committee members may be asked to review deliverables, participate in webinars and provide expertise.
Previous and ongoing agenda topics include:
- Formulary and utilization management strategy
- Data transparency and interoperability
- Cost and delivery of specialty medications
- Precision medicine, including pharmacogenomics, genetic testing and gene therapy
- Drug and supplement safety
- Waste management
- Couponing/copay assistance
- Adherence
- Site-of-care shift
- Biosimilars
- Opioid misuse and abuse