Updated April 21, 2020 to include CPR’s COVID-19 Reporting & Strategy Addendum!
The Case for Consistent Purchaser Demands
Self-insured purchasers have the opportunity to push health plans to drive higher quality and more affordable care for both purchasers and their covered population. But it’s hard to be successful as a lone voice. If every purchaser approaches their health plan with a separate set of priorities, health plans can’t prioritize. But when purchasers band together to create a collective set of demands, health plans have a business case for championing real and sustained improvements in health care quality and affordability.
Since 2013, CPR’s Aligned Sourcing Toolkit has served as a megaphone for purchasers across the country, amplifying their demands for more transparency, payment and delivery reforms, accountability for quality, and lowering the cost of care. By using CPR’s health plan selection, renewal, and contracting language, purchasers can more effectively push health plans to implement the strategies and services they need to succeed as a high-value purchaser.
How to use the toolkit
This toolkit includes editable documents that you can use to set health plan expectations during the health plan selection, renewal, and contracting phases. Specifically, use these templates for the initial request for information, when requesting a renewal quote from an incumbent health plan, and when incorporating language into the final contract.
Included in this toolkit
- 2020 Health Plan Request for Information (RFI): CPR’s RFI serves as a companion to a general sourcing tool, which you can issue to prospective health plans during the health plan selection process. It outlines questions to ask health plans on a wide range of high-value health care strategies, including combating high prices, payment and delivery reform, benefit and network design, and price and quality transparency. In addition, the RFI probes the health plan’s progress in transitioning Accountable Care Organizations (ACOs) to downside risk, and holds health plans accountable for measuring outcomes using CPR’s Standard Plan ACO Report. The RFI is structured to provide flexibility, with core questions spanning the topics above, followed by a series of optional sections covering clinical areas of interest, including as maternity, pharmacy, behavioral health, total joint replacement, genetic testing, and serious illness care.
- 2020 Model Contract Language: This model contract offers language that you can use with your health plan to set expectations for value-oriented payment and care delivery, price and quality transparency, market competition, and tracking progress, i.e., reporting results of these efforts. You can incorporate this language as an addendum to your own health plan administrative services agreement.
- 2020 Renewal Questionnaire: If you are a purchaser who is not conducting an RFI, this resource allows you to track the progress of your incumbent health plan(s) by asking informed questions when soliciting a fee or premium quote for the next Plan Year. This document includes questions on prices, payment, and delivery reform, benefit and network design, and price and quality transparency, among other topics.
- 2020 Coronavirus (COVID-19) Reporting and Strategy Addendum (Added April 21, 2020): As a purchaser, you’re potentially overwhelmed by the rapidly, even daily updates, of COVID-19. You may be wondering what impact the pandemic is having on your health care claims cost and utilization and the mid- to long-term impacts the pandemic will have on your health plan and the health care system. CPR developed this two-page addendum to the Toolkit as a resource to guide you through these discussions with your health plan.
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