CPR was founded on the principle that when health care purchasers unite their voices, they become a powerful force for change.  That is why CPR publishes an Aligned Sourcing Toolkit every year.  The toolkit, which consists of a Request for Information (RFI), Model Contract Language, and a Renewal Questionnaire, provides a cohesive set of mandates for third-party administrators regarding prices and competition, payment reform, network and benefit design, transparency, care delivery and health equity.

CPR updates the toolkit every year to keep pace with the rapidly changing landscape of the health care ecosystem; in this year’s edition, we address the following new/emerging issues, among others:

• National inflation, its impact on labor costs and provider prices, and health plans’ remediating strategies
• Measuring health equity using standardized measures of clinical quality, stratified by race and ethnicity
• Virtual-first plans: their availability and guarantees of quality and cost of care savings

CPR identifies new content for these tools based on the external input and the brain trust of our member organizations.  But no section of escapes scrutiny.

Self-insured purchasers have the opportunity to push health plans to drive higher quality and more affordable care for their organizations and their covered populations.  When purchasers band together to create a collective set of demands, health plans have a business case for championing real and sustained improvements in health care quality and affordability.

CPR’s Aligned Sourcing & Contracting toolkit gives purchasers more effective leverage to push health plans toward proven strategies and services that purchasers need to improve the value of their health care dollar.

How to use the toolkit

This toolkit includes editable documents that you can use to set health plan expectations during the health plan selection, renewal, and contracting phases. Specifically, use these templates for the initial request for information, when requesting a renewal quote from an incumbent health plan, and when incorporating language into the final Administrative Services Only (ASO) agreement.

Included in this toolkit

• 2023 Health Plan Request for Information (RFI):  CPR’s RFI serves as a companion to a general sourcing tool, which purchasers can issue to prospective health plans during the health plan selection process.  It outlines questions to ask health plans on a wide range of issues and high-value health care strategies, including:

• • Combating high and rising prices

• • Addressing provider market power and competition

• • Enhancing price and quality transparency

• • Reforming payment and care delivery

• • Innovating with benefit and network design

• • Improving population health and increasing health equity

• • Improving maternity outcomes

• • Comprehensively reporting and collaborating

The RFI also directs users toward supplemental CPR question sets covering data ownership, access, and use, accountable care organizations, bundled payment, mental health, price and quality transparency tools, total joint replacement, genetic testing, serious illness care, and data warehousing and analytics.

• 2023 Renewal Questionnaire: Designed for purchasers who are not going out to bid for the upcoming year, the Renewal Questionnaire allows purchasers to track the progress of incumbent health plans by asking informed questions when soliciting a fee or premium quote for the next Plan Year. This document includes an abbreviated question set to address many of the same categories in the RFI:

• • Combating high and rising prices

• • Addressing provider market power and competition

• • Enhancing price and quality transparency

• • Reforming payment and care delivery

• • Innovating with benefit and network design

• • Improving population health and increasing health equity

• • Comprehensively reporting and collaborating

Purchasers can also access the Renewal Questionnaire as a stand-alone item.

• 2023 Model Contract Language: This model contract offers language that purchasers can use with health plans to set expectations in critical areas of interest.  We recommend attaching this language as an addendum to a purchaser’s own health plan ASO agreement.  The model contract language is organized by the following sections:

• • Combating high prices and stimulating competition

• • Transparency

• • Provider payment and care delivery reform

• • Benefit and network design

• • Health disparities and care improvement

• • Participation, collaboration, and reporting

As a health care purchaser, you can log in to get FREE access to the Toolkit!

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