MARKET POWER

Massachusetts Slams the Breaks on Mass General’s Expansion Plans: Insights into the Value of State Health Policy Commissions

February 7, 2022

The State of Massachusetts made headlines when its Health Policy Commission (HPC) launched what the press called “a double-barreled attack” on Mass General Brigham’s expansion plans. In the first of its one-two punches, the HPC concluded that Mass General’s $2.3B plan was “not consistent with the Commonwealth’s goals for cost containment.”

Are there surprises with the implementation of the No Surprises Act?

September 13, 2021

Getting these details right will determine if implementation of the No Surprises Act will not only protect patients from most high and unexpected medical costs but also help reduce the need for balance billing in the first place and keep prices in check.

Reference-based pricing: 3 models that cut health care cost inflation at its roots

April 12, 2021

Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.

Dr. Christopher Whaley on Opening the Black Box of Employer Health Care Spending

March 16, 2021

Julianne McGarry catches up with Christopher Whaley, PhD, Policy Researcher at RAND Corporation and one of the lead authors of the RAND’s Hospital Price Transparency Study. The

What Xavier Becerra’s nomination as HHS Secretary could mean for employer-purchasers

December 8, 2020

During the economic recovery, we need competitive health care markets as a counterweight against health care price inflation. With the economy struggling, employers and other health care purchasers have less money than ever to spend on health care and need every tool at their disposal to keep expenses under control. Employers across the country will be watching to see if the Sutter case will serve as a warning to other dominant providers, or if anticompetitive behavior will be given a COVID hall pass. As Secretary of Health and Human Services, Becerra’s understanding of these dynamics will inevitably shape his work on health care delivery and payment reforms, policies regarding transparency of price and quality information, and much more.

Headway & Headwinds in Colorado: What purchasers can do when health systems won’t budge

September 28, 2020

The economic downturn has only heightened the need for Colorado employers to implement high-value health care purchasing strategies. This is challenging due to Colorado’s market dynamics. We decided to revisit the recommendations in CPR’s Denver-Area Market Assessment Report to explore how Colorado can overcome the stalemate with large health systems.

Ashok Subramanian on why unit price is still a big deal

July 28, 2020

Suzanne Delbanco interviews Ashok Subramanian, CEO and Founder of Centivo Health, an alternative Third-Party Administrator (TPA) that emphasizes value-based direct contracting and utilization of high-quality providers.

Alan Muney, MD, on why large health plans have a total cost of care advantage

July 21, 2020

Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers.

50 States Enacting Health Care Policy; One Searchable Database

June 22, 2020

A database might sound like something that only law students and policy wonks care about. But most stakeholders would benefit from understanding the legal constraints and opportunities that state laws create when it comes to improving the functioning of the health care system.