December is a time for reflection: both on the year that passed, and on the year to come. December is also a time for giving – regardless of one’s faith or lack thereof. This got us thinking at CPR: if we could give one gift to the American health care system in 2022, what would it be, and what can we at CPR do to make our wish-list a reality in the year to come?
In a prior blog article on the 2021 KFF Employer Health Benefits Survey, we noted that employers are in the eye of a hurricane and will have to confront some painful tradeoffs when costs spiral again. But the significant exceptions to employers’ “wait and see approach” to health care benefits during the first year of the COVID-19 pandemic are in the areas of telehealth and behavioral health, including at the intersection of the two.
KFF released results from its 2021 survey on trends in employer health benefits. The topline takeaway: not much has changed. Employers appear committed to maintaining the status quo, with a few key adaptations that speak to the necessities of managing health care benefits during a pandemic. In 2021, employers are in the eye of a hurricane, but what comes next?
Purchasers: how many times have you attended a meeting with your health plan that focused solely on high-level concepts and success stories, but not a meaningful, tactical conversation about the issues of greatest concern to you? CPR’s Health Plan User Groups (HPUGs) are like a client advisory group meeting, but turned upside down: the clients, not the health plans, set the agenda, offering a forum for a substantive and rich two-way dialogue.
Colorado passed legislation authorizing the creation of its APCD in 2010. Today, the database houses over 718 million medical, dental and pharmacy claims from 44 payers (including 35 commercial plans). What makes Colorado’s APCD so powerful, however, is its pairing with the publicly-facing reporting and analysis that CIVHC provides.
Suzanne Delbanco speaks with Katy Spangler, Principal at Spangler Strategies, about recent federal activity on health care price transparency and what employers need to know moving forward.
Employers and other health care purchasers – it’s time to step off of the sidelines and onto the field. Across CPR’s membership and broader audience, there has never been more innovation and agency among health care purchasers than there is today.
Suzanne Delbanco connects with Erin Fuse Brown to discuss the No Surprises Act and what employers should be paying attention to with regards to surprise billing protections.
CPR published a collective set of demands that purchasers should include in their ASO agreements. When multiple purchasers ask for the same thing at the same time, it broadcasts a powerful signal to TPAs on purchaser priorities. Among these aspirational yet foundational expectations, the delivery is in the details. Here are three provisions of note in CPR’s latest model contract language.
Suzanne Delbanco catches up with Niall Brennan, President and CEO of the Health Care Cost Institute (HCCI), to ask the tough questions on price and utilization data for employer-sponsored health care.
Dr. Irene Dankwa-Mullan highlights the need for employers and their business associates – including TPAs, consultants, and other partners – to acknowledge that health inequities exist and use their role as plan sponsors and benefits administrators to address them through comprehensive, data-driven, health equity strategies.
Getting these details right will determine if implementation of the No Surprises Act will not only protect patients from most high and unexpected medical costs but also help reduce the need for balance billing in the first place and keep prices in check.
Should employers impose COVID-19 vaccine mandates? The keyword here is “should” (“can” is a legal question that has already been largely answered and is not the subject of this blog). But “should vaccination be required” leaves room for debate. While bioethical analyses typically rely on multiple frameworks, this blog should be considered a primer on two of the ‘hallmark’ bioethical principles: autonomy and justice.
Suzanne Delbanco speaks with Jason Richmond, Head of Consultant Relations at Ginger, a digital mental health care provider. Jason Richmond explores the supply and demand imbalance between mental health patients
Back in October 2019, we published a blog post on the challenges of building a high-performance network (HPN). We landed on the conclusion that an HPN should be designed with sensitivity to
“What’s great about [direct contracting] relationships is they allow for an employer to work directly with a health system in developing a solution that’s specific to their employee base. They can design programs that address their specific needs, such as addressing diabetes issues within their employee population or behavioral health. In return, the health system expects employers to develop benefit plans and contribution strategies that steer their employees to that health system.”
“A provider is always going to want to get paid. They’re always going to call to make sure the member’s covered, and if we’re that single point of entry and can provide that expertise and do it in a way that drives satisfaction for them, they’re more likely to leverage us as we talk about care planning on a go-forward basis.” – Scott Doolittle, CFO, Quantum Health
Will the updated penalties and clarifications proposed by CMS compel hospitals into compliance? The jury is out, but the impact of the proposed updated rules depends heavily on enforcement.
Will telehealth help save health care from unsustainable cost growth and inequities in outcomes? Or will it do the opposite?
Stakeholders across the health care industry are currently drafting their telehealth roadmaps for the future. Virtual-first health plan products are popping up. Providers are figuring out how much of their patient care will continue to stay virtual post-pandemic and studying best practices to effectively engage diverse patients. At the federal level, Congress introduced the CONNECT for Health Act of 2021, which seeks to codify telehealth provisions made during the public health emergency permanently into Medicare. The time is now for health care purchasers – including states – to demand telehealth programs and policies with two clear goals in mind:
Be financially sustainable for those who use and pay for it
Be implemented so that everyone has a fair and just opportunity to benefit
Suzanne Delbanco consults Bob Berenson, MD, Institute Fellow at the Urban Institute, on what’s going on with telehealth payment policy in both Medicare and the commercial sector and why employers
