Catalyst for Payment Reform


Bob Galvin revisits the state of payment reform

Suzanne calls up Bob Galvin, CMO of Blackstone and chairman of CPR’s board of directors, to follow up on their previous discussion on the state of payment reform. So where are we at? Progress is slow, yet steady — we’ve had rain delays, changing pitchers, changing managers, but the game isn’t over.

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Featured Experts who have advised our Members

Being a member of CPR is about so much more than being a leading national voice in the fight for more access, equity, and quality in health care. It’s about being a part of a team who band together to strategically push the health care system. How do members achieve this? CPR creates the space where members can engage with experts, health plans, and CPR staff to incubate trailblazing health care strategy.

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Dr. Jeff Wells speaks about advanced primary care and Marathon Health

Suzanne calls up Dr. Jeff Wells, CEO and co-founder of Marathon Health to talk about advanced primary care models and how it fits in with onsite and near-site clinic, and virtual care.

Suzanne and Jeff dive into the term advanced primary care and how it differs from prior terminology used to describe high-value primary care strategies. In addition, they discuss why there is a lack of primary care providers compared to most other developed countries and what the future looks like for primary care.

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Peter Lee on the last twenty years in health care reform

Suzanne calls up Peter Lee, the former Executive Director of Covered California to talk about the last twenty years in health care reform. He explains how many of the payment reforms executed in the commercial space have really been on the margins, and many employees are spending more for worse care than ever before.

So what’s the problem? Lack of real alignment on measures, and not enough dollars at play at the right level. “We focused a lot on provider level payment…not at the health plans. Health care is a team sport, if we aren’t making the quarterback of the team, the health plans, accountable for quality and value, nothing is going to happen.”

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Aneesh Chopra on Price Transparency and Data

Suzanne calls up Aneesh Chopra, Co-Founder and President of CareJourney, to talk about the current state of health care transparency policy and how the US is faring. So, what’s the mood on current regulations and government oversight? “The general feeling in the field is one of skepticism,” says Chopra, but he’s much more bullish on it. According to Chopra, based on research CareJourney conducted in partnership with Turquoise Health, “two-thirds of hospitals as of the spring of 2022…actually have meaningful, high-quality transparency data.” The question now is are we going to see this information put to use?

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Alice Hm Chen on Covered California’s commitment to health equity

Suzanne calls Alice Hm Chen, Chief Medical Officer at Covered California, and asks about her work in quality measurement and health equity.

As the nation’s largest state-based health insurance exchange, how is Covered California thinking about its responsibility to deliver equitable care to its member population?

“I think a key thing for everyone to embrace is, equity is quality…you won’t get to true high-quality care unless you are addressing equity.”

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Roslyn Murray on Value-Based Payment Models in the Commercial Sector

Suzanne Delbanco speaks with Roslyn (Roz) Murray, a doctoral candidate at The University of Michigan School of Public Health and former Catalyst for Payment Reform employee.

Roz delves into her first peer-reviewed paper in Health Affairs, which concludes that the evidence on commercial value-based payment models is mixed. This is the first systemic review of the quality, spending, and utilization effects of commercial models, extracting results from fifty-nine studies.

Suzanne and Roz dive into why there is such little research in the commercial sector on value-based payment and compare Roz’s findings to research done in the public sector.

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Alexandra Drane on Supporting Caregivers as Critical Care Partners

Suzanne Delbanco speaks with Alexandra Drane, Co-Founder & CEO of ARCHANGELS, diving into the critical role of caregivers and why they must be part of the clinical care team. She also discusses how ARCHANGELS’ Caregiver Intensity Index (CII) is designed to engage caregivers and help them see themselves in the role.

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Jo Porter Gives Suzanne the Scoop on All Things APCD

Suzanne and Jo discuss the recent growth in APCDs across the country, renewed federal interest in APCDs, how states are collecting and sharing the information in their APCDs, and data barriers. Suzanne and Jo also discuss the benefits of APCD data for employers and other health care purchasers looking to create high-value benefits and health care programs for members.

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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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Scott Doolittle on how an independent health care navigation company builds trust with both patients and providers

“A provider is always going to want to get paid. They’re always going to call to make sure the member’s covered, and if we’re that single point of entry and can provide that expertise and do it in a way that drives satisfaction for them, they’re more likely to leverage us as we talk about care planning on a go-forward basis.” – Scott Doolittle, CFO, Quantum Health

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Nate Freese on how data science can improve health care navigation

Suzanne Delbanco speaks with Nate Freese, MBA, Senior Director of Data Strategy at Grand Rounds Health, a health care quality and navigation solution offering employers a data-driven clinical navigation platform paired with patient advocacy tools. Nate leads data strategy at Grand Rounds Health, where his team is responsible for building algorithms that match patients with the right providers based on billions of historical clinical interactions.

Nate offers a helpful introduction to data science by describing the three types of analyses that data science tackles as well as use-cases that help physicians, pharmaceutical companies, and patients make informed value-oriented choices. He then explores the major challenges that health tech companies face in bringing their data use-cases to life, including the siloed and unstructured nature of health data and the talent shortage of data science professionals across the country. Finally, Nate shares the approach Grand Rounds Health uses to track and improve its ability to reduce health care disparities.

Data science simplifies the unimaginably complex and predicts the future to help us make better decisions. In health care, the difference between the right and wrong decision can result in hundreds of thousands of dollars in spend, hospitalizations, or worse. In this episode, you’ll learn how Grand Rounds Health is using data science to power its clinical navigation platform and patient advocacy tools, with an eye toward health equity and cost containment.

Featured quotes:
“Messy data is another challenge for applying data science in health care. The data often requires a lot further processing to make it useful, and is often inconsistent – you have systems with different definitions of the same concept or information. Ultimately, it takes very specific skills sets and domain expertise to make health care data sets useful. And that gets to the next big challenge, which is talent shortage.”

“There’s a big disconnect between the number of companies out there that have a compelling vision for how they could use data in a health care context, and the number of companies that are actually doing so. A big factor is finding the people they need to realize that vision.”

“Data scientists are not one-size-fits-all. It’s usually not that you need 1 or 5 data scientists at your company to realize your vision for using data. It’s more likely that you need a couple of data engineers, you might need a couple of machine learning experts, a natural language processing expert, a statistician and a couple of epidemiologists. Each of these people are data scientists, but they bring a different skillset to the picture, and you need several of them to suite a particular use-case.”

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