What Is Aligned Sourcing?
Aligned sourcing is about creating consistency among employers and other health care purchasers in the requests they make to their health plan partners regarding how they administer the purchaser’s health care benefits and secure the purchase of health care services on their behalf. Aligned sourcing can take place when a purchaser “sources” (i.e. selects) a health plan, contracts with a health plan, and manages a contracted health plan relationship. In all phases, standardized questions and expectations send consistent messages to health plans about purchasers’ priorities, which then prompt health plans to pursue strategies with health care providers that meet the needs of purchasers and the populations they cover.
Why Should Employers and Other Health Care Purchasers Care About It?
Self-insured purchasers have the opportunity to push health plans to implement important innovations that mean higher quality and more affordable care for both the purchaser and its covered population. But it’s hard to be successful as a lone voice. The use of standardized health plan request for information (RFI) questions and contract language can send consistent messages to health plans on purchaser priorities and produce important insights into and requirements on health plans’ contracting strategies. Health plan-provider contracts can create incentives for doctors and hospitals to improve care. Health plans may ask self-funded purchasers to finance these incentives or change benefit designs to steer patients to certain providers. If the purchaser is aware of the existing or future reform strategies being implemented by its health plan, it can help to shape and can better plan around the financial or operational implications for its own health benefit strategies.
What Are the Latest Trends in Aligned Sourcing?
Purchasers identify health plan partners through a broker, a benefits consultant, or directly. Purchasers often perceive that they have unique health benefit needs, so they typically ask health plans questions in a RFI that focus on their specific requirements. When it comes to payment and related reforms, purchasers oftentimes do not know what they should be asking or pose similar but slightly different questions that, together, do not send a clear signal to the health plan about what purchasers want. Unless purchasers provide health plans with consistent signals about what is important to them on payment reform and related issues, plan are left to pursue their own strategies, which may not align with purchaser goals.
How Can Purchasers Use Aligned Sourcing to Procure Higher Value Care?
CPR seeks to help purchasers align on how they communicate their needs and priorities to health plans as part of the sourcing, contracting and management process. For help with sourcing a health plan, CPR’s RFI asks plans about current provider payment practices and other reform strategies. The RFI embodies a menu of reform areas that gives purchasers and health plans the tools to plan for strategies that promote high-quality, cost-effective care. In particular, the RFI also helps purchasers monitor how much physicians and hospitals are paid through the various methods that are sensitive to provider performance or designed to create incentives to improve quality and/or cut waste.
CPR’s model health plan contract language outlines bold expectations by purchasers for progress on payment reform and other related areas by their contracted plans or third party administrators. The model contract highlights immediate ways health plans could reform how they pay doctors and hospitals as well as support reform activities using quality and price transparency, changing how providers deliver health care, and conducting rigorous evaluations of new programs. The model health plan contract can coordinate the purchaser “ask” and articulate clear expectations for payment and related reforms.
When purchasers send consistent signals to health plans about payment reform and other priorities, health plans will be more likely to identify a business case for developing programs that respond to their purchaser-customer needs.
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