Catalyst for Payment Reform

The Action is on the Field, Not the Sideline

The Action is on the Field, Not the Sideline

I’m writing today with an important ask of employers and other health care purchasers – to step off of the sidelines and onto the field.

Across CPR’s membership and broader audience, there has never been more innovation and agency among health care purchasers than there is today.  During my 22 years of work with employers, together, we have helped to introduce and make permanent changes to the health care industry that affected both the commercial and public sectors and lay the groundwork for many of today’s innovations.  These changes include:

  • Use of standard measures to assess the quality of health care providers, enabling direct comparisons among hospitals and physician groups
  • Public reporting on provider performance on quality measures for use by consumers, employer-purchasers, health insurance companies and policymakers
  • Payment tied to that performance and designed to reduce waste and improve the patient experience
  • Transparency of health care prices, cemented by recent federal laws that enjoyed bipartisan support

CPR has also worked to strengthen the employer sector, including by:

  • Pushing the major health insurance carriers through CPR user groups to implement innovative provider payment models and benefit and network designs that improve quality and affordability
  • Providing head-to-head comparisons of vendors used by employers either to supplement or improve health benefit offerings.To date, we have compared vendors of mental health services, data analytics and warehouse companies, bundled payment administrators, as well as vendors who pay providers in multiples of Medicare rates to put downward pressure on prices.
  • Serving as a witness in two landmark antitrust cases against large health care systems whose anticompetitive practices drove up health care prices and restricted employers from using high-value benefit and provider network designs; both cases settled with prohibitions on these anticompetitive behaviors going forward.

While we can celebrate these advances, we’re equally cognizant that there is no quick fix or single solution that can immediately unwind the price distortions, obfuscation, and disintermediation that plague our health care system.  It takes decades of work and an ongoing commitment to stave off the market forces working against employers as health care buyers.

CPR’s purchaser members have launched and scaled programs that produced significant savings and improved outcomes among their plan participants.  Many of them have kept their cost increases well below trend. They are the pioneers, and we regularly broadcast their success to commercial and public payers nationwide to help these programs spread.

However, COVID-19 has instigated additional provider consolidation, further degrading purchasers’ negotiating power.  Both health plans and providers continue to fight new transparency regulations and providers have been slow to comply.  Prices will continue to rise.  Employer-purchasers need continued education and resources and must engage in coordinated efforts to combat these unfavorable market dynamics.

Without a strong employer-purchaser sector, health care spending in the commercial market will continue to increase.  It’s more important than ever to step onto the field.  Here at CPR, you will find a welcoming community of purchasers who like to learn from each other and think two steps ahead about how their purchasing practices impact the dynamics of the health care industry…and ultimately the quality and affordability of care.  Come join us!

CPR’s Executive Director, Suzanne Delbanco, PhD, wrote this blog post.

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