Catalyst for Payment Reform

PAYMENT REFORM

You too can be a health care Catalyst.

Like any 501c3 nonprofit (and many organizations for that matter), CPR must remain nimble.  We recently setup the capability to accept tax-deductible contributions to fund our important work.  You can also get involved with CPR. For example, you can become a member, participate in our enterprise subscription program, collaborate with us on research or thought leadership.  Know that regardless of how you contribute, your support is going to a small, but mighty organization tackling health care’s biggest challenges on behalf of employer-purchasers.

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2023 Health Plan User Groups: No dog and pony shows allowed

Granted, most HPUG meetings veer more toward “engaged conversation” than “heated debate” but this is how CPR moves the Overton Window.  CPR members don’t just ask health plans for updates on how many dollars they’ve dedicated to their bundled payment program: we push them to respond to tough questions in new territory like data sharing, health equity and their post-COVID payment reform strategies.  We make them all take the same test through our program evaluation tools so they can’t cherry-pick statistics or hide behind shiny marketing materials.  And because CPR members set the agenda for the HPUG meetings, the discussions focus on what matters most to you, purchasers, and what keeps you up at night.  It’s OK if the health plans squirm a little; it’s what helps them grow.

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Mythbuster: Purchasers Can’t Fight the Wave of Provider Market Power

on is a massive wave fueled by provider consolidation, increased expenses, and pent-up demand for services (resulting in higher utilization), and it appears ready to break over the industry, bringing with it higher health care prices and [even more] unfavorable market dynamics for employer-purchasers and health plans. Against this wall of provider market power, purchasers may feel powerless with no way to protect themselves but there are both preventive actions and countermeasures they can take to mitigate the impact.

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Whatever we’re doing, it’s not working: The Case for State Policy Intervention in Health Care, as told through a parable about toddlers and swimming lessons

younger daughter Dylan was three, she emphatically declared that she hated swimming lessons. Unfortunately for her, she has a mother (me) who believes with equal conviction that learning to swim is a safety issue and therefore non-negotiable.  Thus, Dylan and I were at an impasse, except that one of us (me) believed that she could convince the other (Dylan) to relent through a combination of authority and influence (and also bribery). One afternoon at our local pool, I found myself pleading, cajoling, promising sweets and screen time (and threatening their removal), if Dylan would just allow me to help her into her bathing suit.  “You don’t even have to go in the water!” I lied.  Dylan didn’t buy it and was expressing her mistrust in a 9-alarm screaming toddler melt-down. It was at that moment that another woman – likely old enough to have grown children of her own – paused and offered the following counsel: whatever you’re trying to do, she said, it isn’t working.

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CPR’s New Year’s Resolutions

As an independent, nonprofit organization with the mission to catalyze employers, public purchasers and others to implement strategies that produce higher value health care and improve the functioning of the health care marketplace, we pride ourselves on our being forward thinking and agile. So, it’s no surprise that we make a list of New Year’s resolutions every year.  This year, we share it with you.

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Is Payment Reform Exiting a 2+Year Shelter-in-Place?

The pandemic stimulated significant uncertainty about the future of payment reform. After all, payment reform is a disruptive strategy, requiring providers to modify practice patterns and payers to negotiate measures of performance by which providers are held accountable for care quality. The early days of the pandemic were a time during which pushing payers and providers on payment reform could have been viewed as being out of touch with the magnitude of the situation. The pandemic created a pause and stimulated leaders to rethink the potential of payment reform. For example, we pondered whether hybrid capitation/fee-for-service would gain momentum as a means for primary care providers to receive guaranteed revenue.  And we continue to ponder it, because frankly, our $4+ trillion health care system doesn’t turn on a dime. CPR has been and remains in the

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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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Any Way the Wind Blows: The Future of Heath Care Payment Reform

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.

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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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