Between health plans, health care providers, and employer-purchasers- who holds the market-shaping power in the Denver area?
Which payment reforms could best improve the quality and affordability of care for Denver residents?
How does the state’s legislative and regulatory landscape affect a health care purchasers’ ability to catalyze change?
These are some of the questions explored in CPR’s Denver-Area Market Assessment report, completed in partnership with the Colorado Business Group on Health. Using CPR’s proprietary Market Assessment Tool (MAT), CPR categorized the health care marketplace dynamics at the Colorado capital, developing tailored recommendations for purchasers interested in implementing payment reform programs.
The Denver Market Assessment report provides a data-driven understanding of the market to identify the most promising ways for purchasers to improve health care value moving forward. Similar to previous market assessments, Catalyst for Payment Reform serves as an independent third-party to help the various stakeholders, who will ultimately need to work together to implement change, understand the local market dynamics and what possibilities are most viable. All health care is local, and payment reform options that may work well in some markets may actually produce unintended negative consequences in others.
The report is structured into four sections:
- An in-depth description of the Colorado health care market landscape – with a specific focus on Denver
- A 360 degree analysis of the three stakeholder groups who most shape payment reform opportunities in a given market, using insights and perspectives from primary interviews
- An overview of the varying market types in existence and how Denver fits into CPR’s typology
- A Denver-specific list of reform opportunities based on market dynamics, public-private partnership opportunities, and legislative conditions.
The report summarizes findings from an analysis of data about the structure of the Denver health care marketplace, an online survey of a mix of 22 stakeholders seeking their perspectives, and primary interviews with 11 key informants.
CPR’s analysis yielded six recommendations that purchasers can use to advance payment reform in Denver:
- Continue building on purchaser momentum, particularly in concert with the statewide purchaser cooperative initiative.
- Implement benefit designs to encourage consumers seek higher value care.
- Align with Medicaid in two-sided risk arrangements and the Polis-Primavera “Roadmap to Affordability.”
- Implement value-oriented programs such as two-sided risk arrangements that hold providers accountable to quality and cost targets.
- Expand on earlier success in enhancing transparency on health care quality and prices.
- Promote the benchmarking of prices relative to Medicare as a means for allowing employers to determine whether the health care prices they are paying are reasonable.