In the commercial market, health plans negotiate rates on behalf of health care purchasers; they use purchasers’ collective volume to command better value for our health care dollars – or that’s how it’s supposed to work. The reality is that health plans have their eyes on dozens of targets at once – which of course includes growing their own market share and being seen as at the leading edge of innovation. If each of their clients approaches them with a separate set of priorities, they can’t prioritize; instead, they focus on the “easy wins” that may not solve for the core problems of access, patient outcomes and price inflation. Those core problems are much harder to solve, and by approaching health plans with a cacophony of demands, it becomes impossible for health plans to find any signal in the noise.
Catalyst for Payment Reform was founded on the recognition that health care purchasers can wield power to change health care foundationally if we align our priorities and create a unified set of demands. In 2012, CPR published our first Aligned Sourcing Toolkit, a set of organized priorities expressed through model contract language, and health plan Request for Information (RFI) questions. We’ve updated these tools every year since and, more recently, developed renewal questions to empower purchasers who are mid-contract with their health plans. Together, purchasers can use these tools to amplify the call for change and reform throughout their health plan sourcing cycle.
When we speak with one voice, we resonate.
These templates demand greater accountability from providers and health plans, greater transparency, and better value for purchasers’ health care spend; to date, they are the backbone of the sourcing strategy for CPR purchaser members who – in total – provide health care coverage for over 17 million Americans nationwide. Every year, CPR updates the toolkit, aligning it with emerging purchaser needs, and the latest research on effective strategies for improved outcomes and affordability.