This toolkit helps employer-purchasers evaluate their third-party administrators’ (TPA) and vendors’ policies toward data ownership, access, and use. To this end, the toolkit includes templates for Requests for Information (RFIs), as well as model contract language that purchasers can add as an addendum to their contracts.
In 2021, CPR uncovered barriers that purchasers and their business associates face with respect to accessing and applying health care data. Purchasers require access to claims and clinical data to implement and evaluate high value strategies and ensure a coordinated experience for their Plan members across different health care vendors.
To address these challenges, CPR convened a multi-stakeholder group of vendors, benefits consultants, and data analytics companies to learn about the barriers TPAs and others erect. Separately, CPR convened a group of purchasers to hear directly how they navigate these issues. The resulting output from this research is a set of tools that purchasers can use to break data gridlock, which include TPA and Vendor Self-Assessments and RFI Questionnaires, TPA administrative services only (ASO) agreement addendum, and Vendor contract language addendum. The toolkit also includes a How-To Guide with additional background on the challenge and instructions for using the tools.
NEW! In May 2023, CPR supplemented this toolkit with a new resource – Purchaser Letter for TPA Gag Clause Removal. This letter provides a template for an employer or other health care purchaser to send to its third-party administrator (TPA), instructing the TPA to remove gag clauses that restrict the purchaser’s access to and use of claims data, or that restrict access and use of claims data by a purchaser’s business associates.
CPR released the toolkit publicly to help set an industry standard and push the marketplace to better meet the needs of employer-purchasers.
How to use the toolkit:
Purchasers can download the customizable tools and send to external TPAs and Vendors for responses. Note that CPR recommends against substantial customization, as purchaser alignment sends a consistent signal to the marketplace. Once users receive the responses, they can evaluate them against CPR’s specifications. Alternatively, users can ask TPAs and Vendors to self-assess their own policies.
Additional Data resources for health care purchasers and consultants:
- Virtual Summit: On January 27, 2022, CPR hosted a two-hour virtual summit to explore how purchasers use data, the challenges they experience in accessing and using it, and discuss the potential impact of recent federal price transparency regulations.
- Toolkit: Evaluating High-Value Data Warehouse & Analytics Solutions: In 2019, CPR appraised data warehouse & analytics companies, and subsequently released a set of evaluation questions and criteria that purchasers can use to conduct their own vendor analysis.
- State of the Data Warehouse & Analytics Marketplace Report: This CPR white paper summarizes general findings from our 2019 evaluations of data warehouse & analytics companies.
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