Catalyst for Payment Reform

If you’re playing without a REF, you can’t trust the scoreboard

If you’re playing without a REF, you can’t trust the scoreboard

Imagine trying to watch or play sports without a referee.  Baseball teams could declare every at bat a home run, regardless of whether the batter even made contact with the ball.  Who’s to stop them?  In soccer: 1 million points for kicking the ball out of bounds, another 500,000 for creative and dramatic flopping.  All games are played like Jacksonville-style Pool in The Good Place.

With this image of utter chaos in your head, consider this: in 2019, the Health Care Payment Learning and Action Network (HCP-LAN) reported that over 60% of health care spend flows through alternative payment models (APMs), yet as a country, we have no standardized way of determining how well these models work.  Instead, each health plan will happily tell you that their ACOs save <insert impressive percentage point> per year, while improving quality.  If you ask health plans, every new payment or benefit design they pilot results in a grand slam home run.  Now, it’s not that health plans are out to deceive, but without guidance on measurement methodology and absent any direction on which quality and utilization measures matter most, health plans are free to choose the ripest, reddest cherries from the cherry tree.

This is why, back in 2017, Catalyst for Payment Reform created the nation’s first Standard Plan ACO Report for Customers, or SPARC.  SPARC solves for the tendency to cherry pick by requiring all health plans to take the same test.  It operates like the nutrition label on the back of every food product at the grocery store. It creates this consistency by standardizing the methodology for measuring cost outcomes and pre-selecting quality measures that are most salient for measuring improvement in outcomes and patient experience.  Since we first published SPARC in 2017, HR benefits leaders from Fortune 100 companies and the largest consulting firms have downloaded the toolkit, and it remains one of CPR’s most popular resources.

Building off of SPARC’s success, CPR is pleased to announce the creation of an entire fleet of Reform Evaluation Frameworks, affectionately known as the REFs.  The five new REFs measure outcomes for the following types of health care models:

  • Centers of Excellence,
  • High Performance Networks,
  • Reference Based Pricing programs,
  • Bundled payment for vendor-convened programs; and
  • Bundled payment for health plan-administered programs.

The REFs measure program performance in terms of cost of care savings, quality outcomes, changes in utilization, and member experience; however, each REF is tailor-made to extract the insights most relevant to each program.  For example, the Reference Based Pricing REF includes a section that examines the program’s impact on provider pricing and which providers members select for elective procedures.  The Bundled Payment REFs measure the savings that accrue from the payment model itself, and also measure the savings from avoided procedures.  The REFs that focus on specialty care (which is all of them except for SPARC and the High Performance Network evaluation tool) include a drop-down menu that allows you to select a list of specialties, and will populate automatically with relevant quality measures.

The five new REFs plus the SPARC are available on CPR’s Tool Library, where you will also find instructional videos that walk you through the tool step by step.  Like all of our online tools and resources, the REFs are available at no cost to health care purchasers.

Photo by Nathan Shively on Unsplash.

Leave a Reply

Contact Us


View Blog Archives