Catalyst for Payment Reform

Webinar #4: Policies for Low-Intervention States & Policies to Protect Competition

This webinar, the final in the series of four, focuses on policies, which, if plotted on a spectrum of “degree of intervention” would land on the lower end of the scale. It also offers strategies for states to protect the erosion of market competition by bolstering and broadening antitrust oversight. Featuring Josephine Porter, Director of the Institute for Health Policy and Practice at the University of New Hampshire and Jaime S. King, the John and Marylyn Mayo Chair in Health Law at the University of Auckland.

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Webinar #3: Policies to Regulate Prices

This webinar, third in a series of four, focuses on policies for price regulation, organized according to the degree of state oversight, resources and sophistication required to administer them. Featuring Anna Doar Sinaiko, Assistant Professor of Health Economics and Policy at Harvard University, Robert A. Berenson, an Institute Fellow at the Urban Institute’s Health Policy Center, and Robert Murray, President of Global Health Payment, LLC.

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Issue Brief #1: The Case for Public Policy Intervention

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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Webinar #4: Policies for Low-Intervention States & Policies to Protect Competition

This webinar, the final in the series of four, focuses on policies, which, if plotted on a spectrum of “degree of intervention” would land on the lower end of the scale. It also offers strategies for states to protect the erosion of market competition by bolstering and broadening antitrust oversight. Featuring Josephine Porter, Director of the Institute for Health Policy and Practice at the University of New Hampshire and Jaime S. King, the John and Marylyn Mayo Chair in Health Law at the University of Auckland.

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Webinar #3: Policies to Regulate Prices

This webinar, third in a series of four, focuses on policies for price regulation, organized according to the degree of state oversight, resources and sophistication required to administer them. Featuring Anna Doar Sinaiko, Assistant Professor of Health Economics and Policy at Harvard University, Robert A. Berenson, an Institute Fellow at the Urban Institute’s Health Policy Center, and Robert Murray, President of Global Health Payment, LLC.

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Webinar #2: Policies to Prevent/Punish Bad Behavior and Empower Market Balancers

This webinar, second in a series of four, focuses on policies to prevent would-be monopolists from engaging in anticompetitive behavior, impose penalties on those that continue to do so, and protect and preserve the independent actors that remain. Featuring Aditi P. Sen, Director of Research and Policy at the Health Care Cost Institute and Erin Fuse Brown, the Catherine C. Henson Professor of Law and Director of the Center for Law, Health, and Society at Georgia State University.

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Cutting Costs: CHG Healthcare Carves Out Specialty Pharmacy

Back in 2016, benefits staff at CHG Healthcare found a charge for $174K in the monthly claims spend report. It wasn’t a mistake; it was the actual price for a specialty drug being used to treat a rare medical condition. Forecasting further exorbitant costs without evidence of effectiveness, CHG Healthcare partnered  with VIVIO Health Inc in 2017 to implement a specialty drug carve-out plan that covers both pharmacy and medical benefit drugs. Between 2017 and 2020, the program netted this progressive purchaser $4.4M in savings with their plan participants paying $0 for their speciality medications.

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Spotlight Suzanne Delbanco

Suzanne Delbanco Executive Director Speaker; Leading Expert in Payment Reform, Focusing on Intersection of Higher-Value Health Care and Price Transparency; Nine-time Selectee of Modern Healthcare’s 100 Most Influential People in

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Issue Brief #6: Pick the Low-Hanging Fruit

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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Issue Brief #5: Regulate Provider Prices

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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Issue Brief #4: Empower Existing Market Balancers

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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Issue Brief #3: Shore up Market Against Consolidation and Rising Prices

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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Issue Brief #2: Policies to Prevent/Punish Bad Actors

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

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