Catalyst for Payment Reform Report Explores Marketplace for Employers/Purchasers Seeking High-value Care

BERKELEY, CA – October 11, 2022 – In the universe of health care vendors, there are market-takers and market-shapers. Market-takers accept health care market dynamics as they are; market-shapers are poised to upend the status quo with strategies that alter the incentives that govern health insurance and care delivery. Catalyst for Payment Reform (CPR) has coined a term for these vendors: market-shaping enterprises (MSEs); they are the subject of a new report and toolkit to help employers and other health care purchasers understand and evaluate the cache of vendors looking to succeed where traditional health insurance companies have fallen short. 

There is a broad spectrum of approaches that vendors have adopted to reshape the health care marketplace. These strategies include disruptive networks and products that elevate high-value providers; they hold providers accountable through alternative payment models and they hand purchasers the steering wheel by enabling them to contract directly with health care providers. 

CPR invited MSEs across six categories of offerings to respond to a request for information based on specifications developed with input from CPR members. The non-profit evaluated vendors on how well they met employer-purchaser specifications that were relevant to their offerings. The six categories are:

1. Alternative payment models
2. Reference-based pricing
3. High-performance networks
4. Centers of excellence
5. Direct contracting
6. Value-oriented benefit design (e.g., incentives for utilizing high-value providers and services) 

“Given that nearly 1 in 3 households do not have enough savings to pay typical deductibles and 1 in 3 Americans delay or skip health care due to its high costs, the time is right for strategies that can reshape the marketplace,” said Suzanne Delbanco, executive director, Catalyst for Payment Reform.

The report provides an overview of this marketplace, what may enable these vendors to be effective and explains these six categories and the factors purchasers should consider in determining whether a market-shaping strategy is a good fit and how best to prepare for a partnership with one of these vendors.

Purchasers who want to initiate their own exploration of these vendors can download CPR’s Evaluation Toolkit at no cost; Health plans, vendors, providers and others can also access this resource for a nominal fee. The toolkit includes the request for information template, which comprises evaluation questions and specifications.

About CPR

Catalyst for Payment Reform (CPR) is a national, independent, nonprofit organization with a 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. For over a decade, CPR has championed efforts to rebalance health care market power and hold the delivery system accountable for outcomes, patient experience and affordability.