Catalyst for Payment Reform

Peter Lee on what alignment means for large purchasers like Covered California

Peter Lee on what alignment means for large purchasers like Covered California

Suzanne Delbanco speaks with Peter Lee, Executive Director of Covered California Health Exchange, to discover how Covered California plans to accelerate positive change in the health care system. Hint: Alignment is at the center.

Peter Lee and his team at Covered California are preparing the contract language for the next phase of work with the 11 insurance carriers that participate in the Health Exchange. In preparation for the drafting of new contracts, Covered California organized three ways to receive meaningful input:

  1. A review of the evidence around value-enhancing strategies, also the topic of a CPR Webinar,
  2. A review of the first 5 years of Covered California, and
  3. A survey of what other private employers are asking from their health plan partners.

All three of these inputs are defining the next phase of Covered California’s work, ensuring their 2.3M enrollees get high-value care while simultaneously transforming the delivery system for the better. What will be included in the new contracts? Areas of focus include shifting resources to advanced primary care, holding ACO’s accountable as integrated delivery systems, and- to echo what other private employers are demanding- improved access and quality in mental health care.

Covered California is a CPR Member and has been advocating for strategies like patient-centered benefit design since at least 2017, when Suzanne first interviewed Peter for our podcast. Benefit design is an effective way for employers and other health care purchasers to improve the functioning of the health care marketplace, as Peter Lee described in a April 2020 Health Affairs blog post. There, he and his co-authors provide a powerful call to action: Employers should push for changes in underlying care delivery that will lower costs over the long term.

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