Catalyst for Payment Reform

COST DRIVERS

Has Price Inflation Got Your Attention? Carpe Diem!

On February 10, 2022 price inflation jumped by 7.5% over the past 12 months, its highest annual increase in 40 years.  For employers and other health care purchasers that monitor their claims cost and utilization data religiously (who doesn’t?), this news prompts questions from purchasers about how inflation will impact their future health care spend.

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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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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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Reference-based pricing: 3 models that cut health care cost inflation at its roots

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. 

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What Xavier Becerra’s nomination as HHS Secretary could mean for employer-purchasers

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. 

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‘Tis the Season For A Teachable Moment (on Price Variation)

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?

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Alan Muney, MD, on why large health plans have a total cost of care advantage

Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers.

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Experts discuss COVID-19 repercussions

What we’ve learned from health care economists, policy experts, and business leaders has begun to illuminate the contours of a new health care economy, re-shaped in the wake of the global pandemic.

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