Catalyst for Payment Reform

Jo Porter Gives Suzanne the Scoop on All Things APCD

Suzanne and Jo discuss the recent growth in APCDs across the country, renewed federal interest in APCDs, how states are collecting and sharing the information in their APCDs, and data barriers. Suzanne and Jo also discuss the benefits of APCD data for employers and other health care purchasers looking to create high-value benefits and health care programs for members.

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All I Want for Health Care in 2022…

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?

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Enhanced telehealth and behavioral health access: rays of light in the eye of the storm?

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.

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KFF 2021 Employee Benefits Survey: Welcome to the Eye of the Hurricane

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?

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CPR’s Health Plan User Groups: An Antidote to the Dog and Pony Show

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.

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The Action is on the Field, Not the Sideline

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.

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Three Provisions to Give Your 2022 ASO Agreement Extra Spice

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.

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Understanding the Bioethics Behind Employer Vaccine Mandates for COVID-19

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.

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Michelle Zettergren on direct contracting, COEs, and employer compliance with new ERISA regulations

“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.”

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Scott Doolittle on how an independent health care navigation company builds trust with both patients and providers

“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

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Feeding two birds with one seed: payment reform, telehealth, & health equity

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

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