A new year always offers a chance for fresh perspective. Keeping the pulse on CPR’s leading edge employer-purchaser members, I truly sense that we are entering an era in which the employer’s role in bringing balance to the health care marketplace – making sure it better meets the needs of those who use and pay for care – will take more of a center stage. How will CPR help employers realize this critical role?
Continue to help purchasers align with each other on what they ask for from health plans & others
Why? CPR coined the term “aligned sourcing and contracting” to describe our theory of change. Employers operating alone rarely have enough leverage to make demands of the health care system, but CPR believes if employers, public purchasers, and Medicaid agencies align specific asks during their sourcing and contracting (like reducing cesarean deliveries or reporting on specific ACO metrics), then health plans, providers, and others will have a stronger business case to respond.
Now available! CPR’s 2019 Aligned Sourcing and Contracting Toolkit (released this week). This flagship resource includes updated request for information questions and model contract language addressing the core elements of our shared purchaser agenda. New in 2019, we’ve added a brief renewal questionnaire for employer-purchasers to make sure their incumbent third-party administrator (TPA) is performing well. Spoiler alert – our tools continue to harp on the need for price and quality transparency, improved maternity care, access to high-quality behavioral health, and rigorous evaluation, among other important areas.
Spotlight the up and coming role of direct contracting
Why? More employers are considering direct contracts with provider groups. This type of arrangement has historically only been used by jumbo employers with enough volume in one market to justify a direct relationship, and enough bandwidth to administer the program. But as a broader swath of employers search for alternative, direct provider strategies, like bundled payments, accountable care organizations, centers of excellence, or onsite clinics, there is an uptick in the number of TPAs and vendors seeking to support these new approaches.
Keep an eye out for: A brand-new eLearning course on direct contracting (Spring 2019). This online course will help employers understand when, why, and how to pursue a direct contract with health care providers. We expect this course to appeal to anyone in the health care industry interested in understanding the challenges and opportunities posed by direct contracting. Later in 2019, we will also evaluate vendors and TPAs that offer bundled payment programs to highlight best-in-class approaches for employers.
Help purchasers evaluate what’s working using standardized parameters
Why? Employers and other health care purchasers are experimenting with health care delivery and payment reforms, as well as benefit and network designs, in pursuit of higher value health care. However, while many value-oriented programs have been implemented, limited data exist to demonstrate their effectiveness. This is due, in part, to the lack of a standard evaluation framework to gauge the impact of such programs. As a result, every evaluation uses different metrics to judge success and results across programs aren’t comparable.
Keep an eye out for: A comprehensive set of Reform Evaluation Frameworks, or REFs, for specific value-oriented programs (February 2019). Each tool addresses a specific value oriented provider payment method, network design or benefit design and is intended to help purchasers collect outcomes data across cost, quality, and utilization. Look for them this February!
Evaluate the current state of data warehouses
Why? With the availability and utility of big data growing by the day, CPR has observed two trends. First, the needs employers have for data analytics are evolving quickly and second, data storage and analytics capabilities are improving and getting cheaper (see last week’s Mythbuster blog). This means employers should think critically about whether their data warehouse is meeting their needs.
Keep an eye out for: CPR Data Warehouse Vendor Scorecards (Summer 2019). The CPR team will spend the first half of 2019 evaluating companies on behalf of our members and will release a scorecard mid-year documenting the state of the marketplace. Note, these scorecards are a CPR members-only benefit!