Rhode Island established a cost growth benchmarking process to bring greater transparency to the market in 2018. The state also has a first-in-the-nation regulation that caps annual growth in prices paid by commercial health plans, established in 2010.
Instead of operating in a transparent arena with defined rules, employers and their contracted partners are struggling to determine who owns which data and how and when it can be shared to inform, operate, and evaluate health benefits programs.
“Are there opportunities to steer to a quality provider or facility down the street? If we can’t do that with the data, then we’re not serving the interest of our employers and their employees and getting them the health care that they need.” – Thi Montavlo, Willis Towers Watson
When the RBP vendor and provider “agree” on a rate, who pays the difference? The RBP vendor or the employer? It depends – and the outcome will likely be reflected in the vendor’s administrative fee.
Suzanne Delbanco catches up with CJ Stimson, MD, JD, the Senior Vice President of Value Transformation at Vanderbilt University Medical Center (VUMC), to discuss Vanderbilt’s direct contract bundled payment arrangement for maternity care with Metro Nashville Public Schools (MNPS).
Nathan Counts, who holds a master’s in mathematics and got his start as an Actuarial Consultant, is at the forefront of the data revolution in health benefits.
Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.
Julianne McGarry catches up with Christopher Whaley, PhD, Policy Researcher at RAND Corporation and one of the lead authors of the RAND’s Hospital Price Transparency Study. The
The digital health explosion has left many employers wondering how to prioritize which bright, shiny new solution to chase, how to discern which solutions are really fool’s gold, and how to get the most from an existing program.
It’s 8pm and, as a supervisor at a grocery store, you’re making sure all employees working the cash registers and self-check-out stands are ready to change shifts and go on
CPR’s Program Director, Andréa Caballero, chats with Stephen Furia, Senior Vice President, Population Health at Mount Sinai Health System. The Population Health division is the business unit within Mount Sinai that works directly with employers and other health care purchasers, providing an array of services including primary care focused near-site health centers, Centers of Excellence arrangements for specialty care, executive health programs, and, more recently, assisting employers in responding to the COVID-19 pandemic.
This 10-day daily email series will guide you around CPR’s resource library so you’ll see the range of topics and product types that we cover. Introducing the “CPR Library Chocolate Box” in the form of a free treat, aka CPR resource, every day leading up to Valentine’s Day.
A tornado is what comes to mind when thinking about the future of alternative payment models (APMs). It’s not because the health care ecosystem (let alone APMs) are poised to wreak horrific destruction upon us all. Rather, the tornado analogy derives from the powerful and influential forces blowing the APM movement in multiple and conflicting directions.
Catalyst for Payment Reform will focus on three strategies in 2021.
The first is to help purchasers stimulate a more competitive and cost-conscious health care system.
CPR’s mission is to help employers and other health care purchasers get better value for their health care dollar. We publish numerous free resources intended to benefit stakeholders across the
During the economic recovery, we need competitive health care markets as a counterweight against health care price inflation. With the economy struggling, employers and other health care purchasers have less money than ever to spend on health care and need every tool at their disposal to keep expenses under control. Employers across the country will be watching to see if the Sutter case will serve as a warning to other dominant providers, or if anticompetitive behavior will be given a COVID hall pass. As Secretary of Health and Human Services, Becerra’s understanding of these dynamics will inevitably shape his work on health care delivery and payment reforms, policies regarding transparency of price and quality information, and much more.
CPR is grateful to both our guests and audience who have contributed to our Listening In (with Permission) podcast series. Since CPR launched the podcast in the spring of 2017,
According to the CDC, 51.8% of Americans age 6 months or older received the flu vaccine during the 2019-2020 flu season; yet, the CDC recommends all individuals in this age range get the vaccine, with limited exceptions. Consumers regularly get the vaccine as part of a primary care visit or at their local pharmacy. In prior years, employers would offer their employees, and sometimes dependents, the added convenience of getting their flu vaccine on-site. This year, however, many employers have limited or eliminated any widescale effort to offer on-site flu vaccines. This means that some consumers will have to seek out their vaccine elsewhere. So, what’s the appropriate site of care for the flu vaccine?
The onset of COVID-19 brought new challenges to San Francisco Health Service System (SFHSS) in its mission to preserve and improve sustainable, high quality health benefits for City and County employees, retirees, and their dependents.
Andréa Caballero, MPA, speaks with Linda Schwimmer, JD, President and CEO of the New Jersey Health Care Quality Institute (Quality Institute) to learn about a pressing issue: the health of New Jersey’s Small Group Insurance Market.
