Catalyst For Payment Reform Helps Employer Purchasers Overcome Health Care Data Barriers

BERKELEY, CA – March 29, 2022 – Employers and other self-insured health care purchasers have long faced obstacles to gaining access to and using their health care claims data to fulfill their Plan fiduciary obligations. To help purchasers overcome these challenges and make the health care system work better for purchasers and consumers alike, Catalyst for Payment Reform (CPR) has released a suite of educational resources and plug-and-play tools. 

CPR’s Purchaser Tools for Breaking Barriers in Data Ownership, Access, & Use is a free, customizable resource for employer-purchasers seeking greater accountability, transparency, and collaboration from their third party administrators and other vendor partners. The toolkit includes a data stewardship assessment, a request for information questionnaire, and model contract language. 

“Disruptive strategies are increasingly required to improve the quality and affordability of health care,” said Suzanne Delbanco, PhD, CPR executive director. “And strategic, value-driven health care purchasing requires access to comprehensive claims and clinical data. We’re fortunate to work with innovative health care purchasers who are eager to use data to connect their health plan participants with higher-quality, less expensive health care providers. However, these purchasers’ efforts can’t work without unobstructed use of their data.” 

As new transparency regulations take effect on July 1, purchasers are seeking all the support they can get to ensure compliance and fulfillment of their health plan fiduciary obligations. CPR’s new resources support that effort. 

“We asked health plans to report their data sharing policies with respect to their clients and their clients’ business associates such as brokers/consultants, data warehouse companies and point solution vendors,” said Ryan Olmstead, director of member services for CPR. “Not surprisingly, each plan responded differently, with some eager to facilitate the flow of data and others with seemingly obstructionist policies. To change this dynamic, self-insured employer-purchasers – from small to jumbo – must clearly articulate their data needs and expectations.”

CPR is calling for all self-insured employer-purchasers to act by:

• Securing ownership of their claims and clinical data by including a core requirement in request for proposal documents. 
• Eliminating gag clauses in their TPA and vendor contracts, which limit access to and use of data and therefore prevent purchasers from fulfilling their ERISA Plan fiduciary obligations. 
• Setting parameters around how long it takes to acquire data for use by themselves and by their business associates.

Enhancing data stewardship – March 30 webinar

CPR hosted a how-to webinar for employers and other health care purchasers on Tuesday, March 30 from 1:00-2:00 pm Eastern. Learn more and watch the recording of Health Care Data: How to Assess whether Your TPA and Vendor Partners will Play Nice in the Sandbox here: https://www.catalyze.org/event/enhancing-data-stewardship-webinar/.

About Catalyst for Payment Reform

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other health care purchasers 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. CPR’s diverse membership includes large private employers, state Medicaid, employee and retiree agencies and other types of health care purchasers and major benefit consulting firms. For more information visit: catalyze.org and follow us on LinkedIn and Twitter.