NBGH health plan effort puts the focus on evidence

The National Business Group on Health, a Washington-based consortium of the nation's largest employers, has formed a committee to promote evidence-based benefit design, and Lincolnshire, Ill.-based benefit consultant Hewitt Associates Inc. has been working with Dr. A. Mark Fendrick and Michael Charnow, a professor of health care policy at Harvard University in Cambridge, Mass., to develop a model for employers seeking to implement evidence-based plan design (see related story).

A few NBGH-members, such as Marriott International Inc. in Bethesda, Md. and Pitney Bowes Corp. in Stamford, Conn., already have begun experimenting with the concept, which has reduced or eliminated copayments for drugs in certain therapeutic classes that have proven to be effective in treating conditions such as heart disease and diabetes.

Another member of the NBGH committee, Juno Beach, Fla.-based FPL Group Inc., is using evidence-based medicine to determine which preventive services to cover in its plan, according to Melissa Miller, director of employee benefits and services at FPL, which is the parent company of Florida Power & Light.

For example, FPL's plan offers incentives to ensure that women have baseline mammograms at age 35, or everyone at least 50 years old receives colonoscopies, and that children receive immunizations.

"We're aligning it with what the evidence is saying is the most appropriate level of care, or if you have a family history," Ms. Miller said.

Although FPL has yet to set limits on care for procedures that the medical literature has not shown to be helpful, "there are discussions about it," Ms. Miller said. "I don't think anyone at this point has been pushing that, although I think that over time, we might see it go that way. This is very early on."