Aligning your approach to sourcing and contracting health plans with that of other purchasers ensures that together you are pushing health plans to commit to implementing the strategies and services you need to succeed as a high value purchaser. This is because as more of us demand the same thing, health plans have a business case for changing how they serve their customers and push for improvements in the quality and affordability of health care. We update our tools each year to reflect new priorities and focus areas for the year.
How to use this toolkit:
This toolkit includes documents that can be used to set expectations of health plans during each phase of the sourcing and contracting cycle, including during the initial request for information and the final contract. We also include a tool to help you check up on your health plan after contracting to ensure you have visibility into progress.
Included in this toolkit
- 2018 Health Plan Request for Information (RFI): CPR’s RFI serves as a companion to a general request for information employers issue to prospective health plan partners. It outlines what a purchaser should ask health plans about on a wide range of high-value health care strategies. including payment and delivery reform, price and quality transparency, and network and benefit design. In addition, the RFI includes questions related to health plan efforts with ACOs, and to improve clinical areas, such as maternity, pharmacy, behavioral health, and total joint replacement.
- 2018 Model Contract Language: This model contract includes language that can be used with your health plan partner to set expectations for value-oriented payment and delivery, quality and price transparency, innovative benefit and provider network designs, as well as reporting results of these efforts. Purchasers can incorporate some or all of the language into their own health plan contracts.
- Payment Reform Check-Up: Purchasers can use the Payment Reform Check-up to set the agenda for regular check-in meetings with their contracted health plan(s) or can ask for responses in writing as needed. This document includes quick check-up questions on payment reform and transparency among other topics.