December is a time for reflection: both on the year that passed, and on the year to come. December is also a time for giving – regardless of one’s faith or lack thereof. This got us thinking at CPR: if we could give one gift to the American health care system in 2022, what would it be, and what can we at CPR do to make our wish-list a reality in the year to come?
So here it is: Catalyst for Payment Reform’s rendition of “All I want for Health Care in 2022” (sung to the tune of the Mariah Carey song “All I want for Christmas is YOU”)
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All I want for Health Care in 2022…
Is for health care prices to come under control. As a lifelong health care reformer, it’s shameful to me that the single biggest driver of health care cost growth in the commercial sector is rising prices. Prices are a result of negotiations between providers and payers and it’s clear who’s winning most of these give and takes. It would be one thing if prices reflected quality, but they do not.
What I’m going to do about it…
I will step in where I help to stop further consolidation among health care providers as I recently did by writing an amicus curiae brief supporting the FTC’s case against the merger between Hackensack and Englewood Health in Bergen County, New Jersey. Mergers help providers amass market power but rarely, if ever, improve patient care or affordability. I will also investigate how states can implement policies to level the playing field and bring competition back to health care.
All I want for Health Care in 2022…
Is standardized definitions for episodes of care. Imagine what it’s like for physician organizations, trying to improve care coordination and efficiency through episode bundled payment models, but catering to 5 (or more) different versions of the same joint replacement episode, each with its own timeframe, quality metrics, and measures of success. Imagine you’re running a state All Payer Claims Database and trying to compare the cost of managing asthma across provider groups – – but there’s no standard definition of what comprises Asthma Care. This is the wild west we live in: across the industry, differing and proprietary black box definitions make it inefficient for providers and payers to adopt episodes and the lack of standard definitions has been one of several barriers to the broader implementation of bundled payment.
What I’m going to do about it…
It’s time to seize the momentum around transparency of health care prices. CPR is supporting the efforts of PACES (Patient-Centered Episode System), a non-profit initiative to create, disseminate, and maintain the clinical specifications for a single, standardized set of episodes of care. These specifications will be fully transparent, and can be used to measure cost, set benchmarks, analyze service patterns, and align quality metrics across systems and regions. Ultimately, transparency into episodes in prices will help patients compare providers on an apples-to-apples basis and enable them to make decisions that in their best interests…not anyone else’s, as it should be.
All I want for Health Care in 2022…
Is for CPR members and other health care purchasers to retain unfettered access rights to their own health care claims data. Health care data provide invaluable information to self-insured purchasers, helping them administer, evaluate, and refine their benefits purchasing strategy. Unfortunately, purchasers experience challenges around gaining access and using the data they and their business associates require.
What I’m going to do about it…
I’m currently leading a multi-stakeholder group in which we’re learning about purchaser challenges to access and use their individual claims and clinical data. In early 2022, CPR will publish a toolkit that purchasers can use to break the data barriers they experience with health plans and other vendors. In addition, this issue will be a focal point for our education efforts, as we will host a virtual summit, address the issue in our health plan user groups, and conduct other public education.
All I want for Health Care in 2022…
Is a ban on anti-competitive contracting clauses between health plans and providers. We can’t expect a competitive health care market if health plans and providers don’t play by the rules. Whether its anti-tiering/anti-steering clauses, which prevent networks from excluding high-cost, low-quality providers; or Most Favored Nation clauses that promise health plans that a hospital won’t negotiate more favorable rates with a regional competitor, these contracting practices consolidate power in the hands of the powerful, and prevent purchasers and their plan members from accessing high-value health care.
What I’m going to do about it…
In 2022, with support from Arnold Ventures, and with guidance from a hand-picked advisory panel of health care policy experts, I’m helping CPR curate an ideal suite of policies that states can pursue to put downward pressure on health care prices and reduce health care expenditures. The consensus is clear that States – as opposed to the Federal Government – are in the optimal position to identify policies best suited to their own economic, political and structural conditions. CPR will offer states guidance on which policies will be most impactful, the prerequisites they need to have in place, and the tradeoffs they must consider. And seriously, can we start with banning anticompetitive contracts? The only reason they’re allowed to persist is out of fear of backlash from the stakeholders who benefit from putting their thumbs on the scale.
All I want for Health Care in 2022…
Is a health care system that truly empowers consumers and is accountable to them – to figure out how we can make real progress toward creating an environment that empowers consumers to take charge of their health and to participate more actively in their own health care.
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What I’m going to do about it…
In partnership with The New York State Health Foundation, I’m helping CPR create the New York State Consumer Empowerment Scorecard – the first of its kind. The goal of the Scorecard is to track the progress of consumer-focused policies and practices in New York State, while aiming to make the health care system more responsive to the needs of consumers. It will achieve this by curating a set of ‘key indicators’ – metrics cross-cutting critical areas of consumer empowerment including equity, access, and system accountability – and shining a light on the State’s progress on these measures. Ultimately, we believe that the Scorecard findings will both educate and inform recommendations for those in a position to spur changes that support consumers.
All I want for Health Care in 2022…
Is for health plans to integrate health equity into their value-based payment models by addressing social determinants of health (SDOH). Creating a more equitable health system will not only improve quality and patient outcomes, but it will also reduce costs by identifying social risk factors up front.
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What I’m going to do about it…
I am synthesizing and publishing health equity results from the 2021 Health Care Payment Learning Action Network (HCPLAN) Alternative Payment Models (APM) survey. For the first time, the HCPLAN, and the public at large, will ascertain the uptake of health equity measures, and how health plans leveraged them in APMs. This will establish a baseline to track health plans’ progress to address health disparities through APMs. Additionally, this will expand provider accountability beyond traditional efficiency and quality metrics, incentivizing them to address the root causes of disparities.
All I want for Health Care in 2022…
Is affordable health care for all purchasers, public, private and individuals. As the person in charge of benefit renewals and open enrollment for Catalyst for Payment Reform employees and their families, I share the pain all health care purchasers face as we confront the tradeoffs of building a business on a tight budget while health care benefit costs continue to climb each year.
What I’m going to do about it…
I will continue to advocate for CPR employees so that they can access the highest value health care benefits the market can provide, and so that they, in turn, can continue to push the market forward toward better value, access and equity for purchasers everywhere.