Catalyst for Payment Reform

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Doug Aldeen takes a deep dive into Reference-based Pricing

January 23, 2023

Julianne calls up Doug Aldeen, ESQ an ERISA Healthcare Attorney and General Counsel to discuss the Reference Based Pricing (RBP) landscape, specifically how RBP has evolved over time.

Doug recounts his experience defending RBP companies from lawsuits and saw the evolution from uniform level reimbursement to variation depending on the market.

“Ultimately, the reason these facilities were coming after the RBP companies is it’s a market threat…you’re now a price maker, instead of a price taker.”

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Sarah Hostetter on how market consolidation affects independent physician practices

January 13, 2023

Sarah Hostetter, Managing Director, Physician and Ambulatory Research at Advisory Board speaks with Suzanne about the landscape of physician practices. Whats happening with acquisition of physician practices?  Are there any independent practices left?  Why do some physicians choose to join larger practices? Sarah digs into the data and sheds light on how the changing landscape affects physicians themselves, but also the market at large.

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Mythbuster: Purchasers Can’t Fight the Wave of Provider Market Power

January 13, 2023

on is a massive wave fueled by provider consolidation, increased expenses, and pent-up demand for services (resulting in higher utilization), and it appears ready to break over the industry, bringing with it higher health care prices and [even more] unfavorable market dynamics for employer-purchasers and health plans. Against this wall of provider market power, purchasers may feel powerless with no way to protect themselves but there are both preventive actions and countermeasures they can take to mitigate the impact.

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Whatever we’re doing, it’s not working: The Case for State Policy Intervention in Health Care, as told through a parable about toddlers and swimming lessons

January 9, 2023

younger daughter Dylan was three, she emphatically declared that she hated swimming lessons. Unfortunately for her, she has a mother (me) who believes with equal conviction that learning to swim is a safety issue and therefore non-negotiable.  Thus, Dylan and I were at an impasse, except that one of us (me) believed that she could convince the other (Dylan) to relent through a combination of authority and influence (and also bribery). One afternoon at our local pool, I found myself pleading, cajoling, promising sweets and screen time (and threatening their removal), if Dylan would just allow me to help her into her bathing suit.  “You don’t even have to go in the water!” I lied.  Dylan didn’t buy it and was expressing her mistrust in a 9-alarm screaming toddler melt-down. It was at that moment that another woman – likely old enough to have grown children of her own – paused and offered the following counsel: whatever you’re trying to do, she said, it isn’t working.

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CPR’s New Year’s Resolutions

December 23, 2022

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.

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Gloria Sachdev on Sage Transparency

November 28, 2022

Suzanne calls up Gloria Sachdev to discuss the Employer’s Forum of Indiana’s (EFI) latest tool, Sage Transparency. Sage Transparency is a tool that brings together public and proprietary data on hospital pricing and quality. It gives users access to price and quality data for thousands of hospitals across the United States—and it’s free!

So what do the data say? Well, they confirm a lot of what employer-purchasers are feeling at the moment.

“We’re seeing just about the fastest rate of health care inflation in our data ever.”

What’s a solution? Price Transparency Data.

We have all of this price transparency data, what are we going to do with it?

Well, we need a new model if we’re going to get consumers to use it. We have to get to them upstream, we have to make it really simple, and we have to change the incentives so that they save thousands of dollars by getting with the program.

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Marilyn Bartlett on NASHP’s Hospital Cost Tool

November 28, 2022

Suzanne speaks to Marilyn Bartlett about the National Academy for State Health Policy’s (NASHP) Hospital Cost Tool and her role in creating it. NASHP’s interactive Hospital Cost Tool provides anyone from policymakers to researchers with insights into how much hospitals spend on patient care services. The tool also shows how those costs relate to both the hospital charges (list prices) and the actual prices paid by health plans.

So what do the data say? Well, they confirm a lot of what employer-purchasers are feeling at the moment.

“We’re seeing just about the fastest rate of health care inflation in our data ever.”

What’s a solution? Price Transparency Data.

We have all of this price transparency data, what are we going to do with it?

Well, we need a new model if we’re going to get consumers to use it. We have to get to them upstream, we have to make it really simple, and we have to change the incentives so that they save thousands of dollars by getting with the program.

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CPR’s Thanksgiving Top Pods Blog

November 18, 2022

CPR is thankful for all the top health care minds who have taken time out of their busy schedules to join us on our Podcast, Listening In (With Permission). CPR surpassed 100 episodes this year and we are not slowing down. Please take the time to listen to our top 5 most listened to episodes of 2022 (so far).

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Is Payment Reform Exiting a 2+Year Shelter-in-Place?

November 14, 2022

The pandemic stimulated significant uncertainty about the future of payment reform. After all, payment reform is a disruptive strategy, requiring providers to modify practice patterns and payers to negotiate measures of performance by which providers are held accountable for care quality. The early days of the pandemic were a time during which pushing payers and providers on payment reform could have been viewed as being out of touch with the magnitude of the situation. The pandemic created a pause and stimulated leaders to rethink the potential of payment reform. For example, we pondered whether hybrid capitation/fee-for-service would gain momentum as a means for primary care providers to receive guaranteed revenue.  And we continue to ponder it, because frankly, our $4+ trillion health care system doesn’t turn on a dime. CPR has been and remains in the

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Karen Sepucha on shared decision making

November 7, 2022

Suzanne calls up Karen Sepucha, PhD, director of the Health Decision Sciences Center in the General Medicine Division at Massachusetts General Hospital and an associate professor in Medicine at Harvard Medical School to discuss shared decision making.

So what do the data say? Well, they confirm a lot of what employer-purchasers are feeling at the moment.

“We’re seeing just about the fastest rate of health care inflation in our data ever.”

What’s a solution? Price Transparency Data.

We have all of this price transparency data, what are we going to do with it?

Well, we need a new model if we’re going to get consumers to use it. We have to get to them upstream, we have to make it really simple, and we have to change the incentives so that they save thousands of dollars by getting with the program.

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Nick Reber on Doctor Quality Analytics

October 31, 2022

Suzanne calls up Nick Reber, CEO and Founder of Garner Health to talk price transparency, analytics, and quality.

So what do the data say? Well, they confirm a lot of what employer-purchasers are feeling at the moment.

“We’re seeing just about the fastest rate of health care inflation in our data ever.”

What’s a solution? Price Transparency Data.

We have all of this price transparency data, what are we going to do with it?

Well, we need a new model if we’re going to get consumers to use it. We have to get to them upstream, we have to make it really simple, and we have to change the incentives so that they save thousands of dollars by getting with the program.

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