This toolkit contains evaluation questions and detailed specifications for evaluating Market-Shaping Enterprises.
In the universe of health care vendors, there are market-takers and market-shapers. Market-takers accept health care market dynamics as they are; market-attempt to upend the status quo with strategies that alter the incentives that govern health insurance and care delivery. Some of these vendors offer a full suite of third-party administrator (TPA) services; others offer innovative network, benefit design and contracting models but do not pay claims. That’s why CPR calls these vendors Market-Shaping Enterprises (MSEs).
The strategies that these vendors deploy are manifold, but include any of the following core elements:
- Alternative Payment Models (APMs)
- Reference-based Pricing (RBP)
- High-performance Networks (HPNs)
- Centers of Excellence (COEs)
- Direct Contracting
- Value-oriented Benefit Design
In 2022, CPR evaluated seven (7) MSE vendors to profile and assess their suites of market-shaping capabilities, against purchaser-vetted specifications. . To this end, we developed a Request for Information (RFI), which covers the strategies listed above, and also core capabilities that CPR considers as table-stakes for any health care vendor.
CPR is pleased to offer this RFI and question specifications publicly through this MSE vendor evaluation toolkit, which identifies attributes that can help purchasers understand vendors’ value proposition and service offerings. CPR is releasing the toolkit publicly to help set an industry standard and push the marketplace to better meet the needs of employer-purchasers.
For purchasers interested in conducting their own evaluation of MSE vendors, or measure the performance of an existing vendor partner, the toolkit contains:
- Request for Information (RFI) Template – includes all questions CPR fielded to vendors in the course of our MSE study, and the purchaser-validated specifications CPR used to evaluate vendor responses. The RFI is organized into 6 sections covering the general product description, prices, payment, and delivery reform, network design, benefit design, navigation and transparency, reporting, and results.
- MSE Evaluation Framework – provides a standardized strategy evaluation tool that purchasers can use to look at MSEs strategies’ and how well they alter the incentives that govern health insurance and care delivery. This will evaluate changes in network and benefit design strategies that evaluate high-value providers and hold them accountable through alternative payment models.
How to use the toolkit:
Employer-purchasers and their consultants can download the editable evaluation framework, customize it to their needs, and send to external partners for responses. Once users receive responses, they can compare them to CPR’s specifications. CPR also encourages health plans, providers, and vendors to use the toolkit to internally evaluate their programs against employer-purchaser expectations.
Additional MSE resources for health care purchasers and consultants:
- White Paper: Market-Shaping Enterprises: New Vendors Want to Rescue Health Care examines the evolution, mechanisms and strategy behind MSE solutions, and explores the most important questions health care purchasers should consider when evaluating an MSE vendor. This paper is free for all audiences.
- Summary scorecards: Profiles of the 7 vendors who participated in CPR’s MSE study, which are available for purchase and free for CPR members.
- Detailed scorecards: Verbatim responses from RBP vendors for the full set of questions included in the RFI, an exclusive resource for CPR members. Purchasers interested in CPR membership should contact Ryan Olmstead (firstname.lastname@example.org)
- Virtual Summit: On October 11th, CPR hosted a 90-minute virtual summit to share key findings from our research, and invite panels of MSE experts and MSE customers to share their insight and experience. A recording of the summit is available to health care purchasers for free, and to all others for a nominal fee.
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