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Using Policy Levers to Drive Change: A Last Resort?

Let’s face it. Something has got to give. While employers and health care purchasers have long tried to implement market-based solutions, catalyzing consistent and long lasting system-wide change in health…

Cutting Costs: CHG Healthcare Carves Out Specialty Pharmacy

Back in 2016, benefits staff at CHG Healthcare found a charge for $174K in the monthly claims spend report. It wasn’t a mistake; it was the actual price for a specialty drug being used to treat a rare medical condition. Forecasting further exorbitant costs without evidence of effectiveness, CHG Healthcare partnered  with VIVIO Health Inc in 2017 to implement a specialty drug carve-out plan that covers both pharmacy and medical benefit drugs. Between 2017 and 2020, the program netted this progressive purchaser $4.4M in savings with their plan participants paying $0 for their speciality medications.

Partnering for High-Quality Care

Discover how the power of collaboration and innovation is revolutionizing healthcare delivery. Blue Shield of California, in partnership with the San Francisco Health Service System (SFHSS), is proud to present…

Issue Brief #6: Pick the Low-Hanging Fruit

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

Issue Brief #5: Regulate Provider Prices

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

Issue Brief #4: Empower Existing Market Balancers

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

Issue Brief #3: Shore up Market Against Consolidation and Rising Prices

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

Issue Brief #2: Policies to Prevent/Punish Bad Actors

Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.

CPR’s New Year’s Resolutions

As an independent, nonprofit organization with the mission to catalyze employers, public purchasers and others to implement strategies that produce higher value health care and improve the functioning of the health care marketplace, we pride ourselves on our being forward thinking and agile. So, it’s no surprise that we make a list of New Year’s resolutions every year.  This year, we share it with you.

CPR Library Chocolate Box

This 10-day daily email series will guide you around CPR’s resource library so you’ll see the range of topics and product types that we cover. Introducing the “CPR Library Chocolate Box” in the form of a free treat, aka CPR resource, every day leading up to Valentine’s Day.

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