The COVID-19 pandemic laid bare the chasm of health care disparities that still plague the health care delivery system.  But as BIPOC individuals and others at risk of discrimination know well, issues of health equity and health care disparities have plagued health care for decades.  Strategies to address health disparities cut across health care purchasing, including benefit design, network design, and payment reform.

With this in mind, CPR updated its Aligned Sourcing & Contracting toolkit by brainstorming and seeking external input on areas of opportunity for employer-purchasers to push for health equity.  But no section of these tools escaped scrutiny; for example, CPR made updates to address new transparency regulations, health care price inflation, navigation tools, and other high-priority areas.

Self-insured purchasers have the opportunity to push health plans to drive higher quality and more affordable care for their organizations and their covered populations.  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.

CPR’s Aligned Sourcing & Contracting toolkit gives purchasers more effective leverage to push health plans toward proven strategies and services that purchasers need to improve the value of their health care dollar.

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 Administrative Services Only (ASO) agreement.

Included in this toolkit

• 2022 Health Plan Request for Information (RFI):  CPR’s RFI serves as a companion to a general sourcing tool, which purchasers can issue to prospective health plans during the health plan selection process.  It outlines questions to ask health plans on a wide range of issues and high-value health care strategies, including:
  • Combating high and rising prices
  • Addressing provider market power and competition
  • Enhancing price and quality transparency
  • Reforming payment and care delivery
  • Innovating with benefit and network design
  • Improving population health and increasing health equity
  • Improving maternity outcomes
  • Comprehensively reporting and collaborating

The RFI also directs users toward supplemental CPR question sets covering data ownership, access, and use, accountable care organizations, bundled payment, mental health, price and quality transparency tools, total joint replacement, genetic testing, serious illness care, and data warehousing and analytics.

• 2022 Renewal Questionnaire: Designed for purchasers who are not going out to bid for the upcoming year, the Renewal Questionnaire allows purchasers to track the progress of incumbent health plans by asking informed questions when soliciting a fee or premium quote for the next Plan Year. This document includes an abbreviated question set to address many of the same categories in the RFI:
  • Combating high and rising prices
  • Addressing provider market power and competition
  • Enhancing price and quality transparency
  • Reforming payment and care delivery
  • Innovating with benefit and network design
  • Improving population health and increasing health equity
  • Comprehensively reporting and collaborating

Purchasers can also access the Renewal Questionnaire as a stand-alone item.

• 2022 Model Contract Language: This model contract offers language that purchasers can use with health plans to set expectations in critical areas of interest.  We recommend attaching this language as an addendum to a purchaser’s own health plan ASO agreement.  The model contract language is organized by the following sections:
  • Combating high prices and stimulating competition
  • Transparency
  • Provider payment and care delivery reform
  • Benefit and network design
  • Health disparities and care improvement
  • Participation, collaboration, and reporting

Forthcoming!  View the June 2, 2022 recording that discusses the importance of purchaser alignment and reviews these resources.