Catalyst for Payment Reform


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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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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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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Want to improve maternity care? Embrace health equity

Health equity provides the principles and framework to address the maternal health disparity crisis in the U.S. The premise is simple: By improving care for those most likely to face poor outcomes, stakeholders can ensure that the health system is preventing poor outcomes for all patients.

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A $4,999.00 Surprise

What happens when a patient goes to the emergency room and gets treated by a doctor that’s out of network – even if the hospital facility is in-network? Or if

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