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Navigating Provider Quality in the Pursuit of Greater Value

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Shane Wolverton discusses quality at the 2nd Annual National Hospital Price Transparency Conference.

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RAND 3.0

RAND Corporation

The National Hospital Price Transparency Study focused on claims data over the 2016 to 2018 period . . . from 3,112 hospitals and 49 states – accounting for $33.8 billion in spending by private payers.

Background on this data set

National Hospital Price Transparency Report Supplement

RAND Corporation

Downloadable database to conduct independent price analyses within and across states.

Download the data

RAND 3.0 Study Findings

RAND Corporation

Christopher Whaley, lead architect of the RAND 3.0 Hospital Price Transparency Study discusses key . . . findings from the third iteration of the study. (From the 2nd Annual National Hospital Price Transparency Conference). Download the slides

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Best Practices in Group Purchasing

Catalyst for Payment Reform

Catalyst for Payment Reform’s research assesses the effectiveness of past and current strategies to . . . aggregate volume at the local level through group purchasing and other approaches, and describes viable models that enable aggregation of covered lives at a local level.

Report will be available by Q4 2020

Sources of Quality Information Issue Brief

Employers’ Forum of Indiana

This research brief describes five categories of quality measures, offers a framework for mapping . . . quality measures to measurement purpose, and analyzes sources of hospital quality ratings.

Read the brief

Buying Value Measure Selection Tool

The Robert Wood Johnson Foundation

This free suite of tools is intended to assist purchasers in creating health care quality measure . . . sets. Users can filter through over 700 measures, and receive an alignment score for the measure set under consideration.

Browse the toolkit

Market Dynamics – Getting Started

Catalyst for Payment Reform

This portfolio of resources is designed to help purchasers understand how the structure and . . . characteristics of the market and stakeholders can significatly impact the options for and success of reform measures.

Access market assessment resources

Catalyst for Payment Reform Market Assessment Tool

Catalyst for Payment Reform

Learn how CPR uses its Market Assessment Tool to to determine market typology and the distribution . . . of power within the market, and to identify which reforms have the highest probability of improving quality and affordability.

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The ripple effect of provider consolidation and price increases

Catalyst for Payment Reform

Marty Gaynor, economics professor at Carnegie Mellon and former Director of the Bureau of Economics . . . at the Federal Trade Commission, discusses the underlying dynamics of the health care marketplace.

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Research Report: Centers of Excellence

The Urban Institute

The Urban Institute provides an overview of COE program mechanics; the report summarizes the model’s . . . strengths and limitations, and recommends design choices to mitigate against potential pitfalls.

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Site Neutral Payment – literature review

Employers’ Forum of Indiana

New research shows that for services like chemotherapy, costs can vary significantly depending on . . . where the care is delivered, without any difference in care quality or outcomes. This literature review examines evidence arguing for site-neutral payment, and explores strategies purchasers can use to direct patients away from low-value sites of care.

Download the literature review

Literature Review on Evidence for Tiered and Narrow Networks

Employers’ Forum of Indiana

This overview of tiered and narrow networks explains their typology and prevalence, summarizes . . . savings and utilization outcomes as documented in peer-reviewed literature, and discusses how these models are likely to evolve going forward.

Download the literature review

What Is Direct Contracting?

Catalyst for Payment Reform

Take a deep dive into direct contracting strategy with CPR. Resources include blog posts and . . . articles, webinars and case studies from employers who have successfully launched their own direct contracts, as well as a 300-level online course covering everything from the pros and cons of a direct contracting strategy to the operational blueprints for launching one.

Visit the website

Making Use of Hospital Pricing Data: Sample Presentation

Employers’ Forum of Indiana

Use this presentation template to present at your first coalition meeting. The template includes . . . talking points and information on the forces that drive price variation and health care cost inflation and the RAND Hospital Price Transparency study. Customizable slides walk meeting participants through hospital price results for your market, and tee up discussion of participant preferences and next steps.

Download the presentation template

Making Use of Hospital Pricing Data: Excel Tool for Populating PowerPoint Slides

Employers’ Forum of Indiana

Using the RAND Hospital Price Transparency Study data, this Excel tool provides charts and graphs . . . you can use to populate your meeting presentation. In each tab, select your market of interest, and graphs and tables will automatically update with relevant data and key findings. (Details provided within the Instructions tab of the Excel file).

Download the Excel tool

Interview with Bob Smith – President, Colorado Business Group on Health

Employers’ Forum of Indiana

The Colorado Business Group on Health is one of the business coalitions engaged with the RAND . . . Employer Hospital Price Transparency Study. Andréa Caballero, Program Director for Catalyst for Payment Reform, interviews Colorado Business Group on Health (CBGH) Executive Director, Robert Smith, to learn how CBGH is using the findings to shape purchaser-led action in pursuit of better value health care for patients and purchasers.

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Policies to Protect Independent Practices

Employers’ Forum of Indiana

Provider consolidation – health system mergers and acquisitions of independent provider practices – . . . drives up prices, has minimal to no impact on quality, and the trend shows no signs of abating. This does not, however, mean that ongoing consolidation is inevitable. This issue brief outlines strategies stakeholders can take to soften the impact of provider consolidation and help retain provider independence where it exists.

Download the issue brief

Sample Outreach Email to Coalition Members

Employers’ Forum of Indiana

Use this template to invite like-minded purchasers to discuss hospital pricing data in your market, . . . and align on a strategic approach to achieve greater health care value and affordability.

Download the outreach email

Making Use of Hospital Pricing Data: Pre-Meeting Survey

Employers’ Forum of Indiana

Use this survey to collect preliminary information about your coalition participants including their . . . size, current portfolio of contracting and network solutions, and strategies they would like to pursue as part of your coalition. You can then use the presentation template and Excel tool below to turn your survey data into visual results.

Download the pre-meeting survey

Purchaser statement on hospital prices

Employers’ Forum of Indiana

This model public statement is designed as a template “call to action,” outlining policies aimed at . . . health plans, providers, and state and federal government. Purchasers – or coalitions of purchasers – can use this template to demand greater price and quality transparency, insist on full and unobstructed rights to their claims data, and shine a light on the need to end providers’ and health plans’ anti-competitive business practices.

Download the statement template

Policies to Mitigate the Impact of Provider Consolidation

Employers’ Forum of Indiana

Consolidation and the market power shift toward health care providers drives up prices and has . . . minimal to no impact on quality. But even in highly consolidated markets, policies at the federal and state level can prohibit anti-competitive practices and tamp down inflation trend. This issue brief examines measures state and federal policy makers can take – even in highly consolidated markets – to demand transparency, mitigate price inflation, and prohibit monopolistic behaviors of large and/or influential health systems.

Download the issue brief

Sources of Quality Information – Overview

Employers’ Forum of Indiana

This research brief describes five categories of quality measures, offers a framework for mapping . . . quality measures to measurement purpose, and analyzes sources of hospital quality ratings. The brief is accompanied by an index of quality data sources, which catalogs whether each source is free or for purchase, which providers and populations it evaluates, the measures it includes and the methodology it uses, along with the nature of the data. Download the brief

Download the Quality Source Index

Interactive Hospital Price Map (RAND 2.0)

RAND Corporation

Interactive map to compare hospital prices based on data from the National Hospital Price . . . Transparency Report (RAND 2.0).

View the map

Frequently Asked Questions

Employers’ Forum of Indiana

FAQs about the National Hospital Price Transparency Studies.

Download the document

Summit in Sight: Peak Health Alliance Targets High Prices in Trailblazing Effort

Colorado Health Institute

Learn how Peak Health Alliance, a group of large and small employers in Colorado, used the state’s . . . all-payer claims database (APCD) to negotiate directly with providers and lower the cost of health care. With projected savings of over 50% compared to 2019 premiums, the Peak Health Alliance began offering coverage in their new health plan on January 1, 2020.

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The National Employer-Led Hospital Price Transparency Study: Results from Rounds 1.0 and 2.0 and Gearing up for Round 3.0

Employers’ Forum of Indiana

Chapin White, lead architect of the RAND 1.0 and RAND 2.0 Hospital Price Transparency Study, . . . explains why price transparency is central to better value health care, and discusses key findings from the first two iterations of the study (RAND 1.0 and 2.0).

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Cheryl DeMars on Achieving Longevity in Group Health Care Purchasing

Catalyst for Payment Reform

Listen in as CPR’s Suzanne Delbanco calls Cheryl DeMars, President & CEO of The Alliance – a . . . cooperative of 240 self-funded employers pooling their purchasing power to control costs and improve quality. Find out why the Alliance was formed and how it continues to deliver strong results through innovative strategies, like Quality Path and high-value primary care.

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Leveraging Market Dynamics in Health Care Innovation: Qualcomm Incorporated

Catalyst for Payment Reform

This case study documents how Qualcomm Incorporated (Qualcomm) examined local market dynamics before . . . successfully launching an accountable care organization (ACO) program for its employees and their families. After reviewing health care cost and quality variation, assessing their unique health care market, and evaluating proposals from providers and carriers, Qualcomm selected Scripps Health and UnitedHealthcare for its direct contract arrangement, designed to deliver a superior experience for patients.

Download the case study (requires free account)

Gloria Sachdev on Hospital-level Price Transparency

Catalyst for Payment Reform

Listen to Gloria Sachedev, PharmD, President and CEO of the Employers’ Forum of Indiana, discuss how . . . the Hospital Price Transparency Study was born, how the data was produced, and what employers are doing with the results.

Listen to the podcast

Additional Background: Sample Purchaser Report

RAND Corporation

RAND Hospital Price Transparency Study participants can request a personalized report that provides . . . pricing information for their most heavily used hospitals. RAND’s analysis compares purchaser paid amounts to hospitals against Medicare allowed amounts, and models savings if multiples of Medicare rates were used. The sample report illustrates the full scope of analysis participating purchasers receive.

Download the sample report

RAND 2.0

RAND Corporation

The National Hospital Price Transparency Study focused on data from 2015 to 2017 and included claims . . . data from 4 million people who received hospital services from 1,851 hospitals in 24 states.

Background on this data set

National Hospital Price Transparency Report Supplement

Rand Corporation

Downloadable database to conduct independent price analyses within and across states.

Download the data

Private Health Plans Pay Hospitals 241% of What Medicare Would Pay, RAND Study Finds

RAND Corporation

Press release from RAND 2.0 Hospital Price Transparency Study which included 1,598 hospitals in 25 . . . states.

Download the document

Rob Paczkowski on getting Googlers to high-value providers

Catalyst for Payment Reform

Learn from Google’s former Healthcare Delivery Benefits Manager how Google’s benefits team utilizes . . . innovative communication channels to build awareness among employees about in-network, high-value health care options, including telemedicine, on-site clinics, and home health care.

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Controlling Costs through Policy Solutions

Catalyst Payment Reform

In an increasingly complicated and blurry landscape, stakeholders across the health care industry . . . are searching for ways to control health care costs, improve quality, enhance access to care, and maintain fair market power. This webinar, featuring David Muhlestein, Chief Research Officer at Leavitt Partners, and Niall Brennan, President and CEO of the Health Care Cost Institute, brings some of these issues into clearer focus – highlighting complex areas of health care strategy that may need policy solutions at the state and federal level to catalyze change.

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Reference-Based Pricing – Leveraging State Purchasing Power to Lower Health Care Spending

National Academy for State Health Policy (NASHP)

Marilyn Bartlett (Montana) and Dee Jones (North Carolina) discuss how their states implemented . . . Medicare PLUS contracting for their state health plan employees, including the challenges they faced in compelling providers to accept this strategy and how they overcame them.

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What it Takes to Move to Value-Based Hospital Payment Models in the Commercial Market

National Hospital Price Transparency Conference

Presentation and panel discussion moderated by Bob Smith of the Colorado Business Group on Health at . . . the National Hospital Price Transparency Conference in Indianapolis, Indiana.

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Consumer-Focused Health System Policy Roadmap and Toolkit

Altarum Healthcare Value Hub

This report introduces a framework (“roadmap”) that policy makers and advocates can use to evaluate . . . the efficacy of health care policy solutions. The report deploys this framework to evaluate local health care policies, highlighting solutions with the greatest evidence base and potential for success, and includes a toolkit highlighting federal, state and local policies to achieve health system transformation.

Access the report and toolkit

Healthcare Cost Drivers: High and Rising Unit Prices

Altarum Healthcare Value Hub

The Healthcare Value Hub’s report on Health Care Cost Drivers explains the connection between health . . . care price, utilization and spend, demonstrating that the increases in health care unit prices are responsible for driving up spend, despite declines in utilization.

Read the article

High-Value Care: Strategies to Address Underuse

Altarum Healthcare Value Hub

Research shows that Americans are only receiving 55% of recommended preventive and maintenane care, . . . so the goal of reducing low-value care needs to be balanced with an emphasis on increasing the provision of high-value care. The Healthcare Value Hub offers recommendations to address underuse, including value-based insurance design and provider and consumer incentives.

Read the brief

A Tough Negotiator Proves Employers Can Bargain Down Health Care Prices

National Public Radio

This article takes a closer look at Marilyn Bartlett and her bold strategy to mandate Medicare . . . Reference Pricing for Montana’s state employee health plan. Bartlett’s success hinged on two factors: obtaining hospital pricing data and engaging stakeholders to pressure hospitals to accept the Medicare reference-based contract.

Read the article

Quality Measures that Matter Action Brief

Catalyst for Payment Reform

This action brief provides a summary of CPR’s selected “Quality Measures that Matter,” and describes . . . the actions a purchaser should take to utilize quality measurement in their health care decision-making.

Download the action brief

Centers of Excellence: Walmart, Inc.

Catalyst for Payment Reform

What did one self-funded purchaser do upon seeing how vastly quality of care varied for spine . . . surgeries? They designed and implemented a successful center of excellence program. Learn the ropes for direct contracting, benefit design, and what it means to collaborate effectively on a COE program from Walmart Stores, Inc. and its key partners.

Download the case study (requires free account)

Centers of Excellence: Walmart, Inc.

Catalyst for Payment Reform

Learn about Walmart, Inc.’s 2013 centers of excellence (COE) program for spine surgery to address . . . variation in quality of care and inappropriate care. This case study details Walmart’s strategies for COE program design, choosing partners, implementation, and employee communications. It also shares cost, quality and utilization results. Download the case study (requires free account) Read Harvard Business Review article (requires paid account)

Listen to the podcast

Enhanced Access with Telehealth: CHG Healthcare

Catalyst for Payment Reform

CHG Healthcare saved over $463,000 through its telehealth program, which they implemented to address . . . the health care needs of their traveling workforce and reduce unnecessary ER utilization. The case study explores how CHG designed its telehealth strategy, identified the right partners, and launched a successful implementation.

Download the case study (requires free account)

Case Study: Home Depot Reference Pricing Program

Catalyst for Payment Reform

Learn about the RBP program The Home Depot, Inc. implemented to address price variation and . . . unnecessary spending. This case study reviews their strategic approach to selecting services and pricing, and their focus on employee communications to ensure smooth implementation.

Download the case study (requires free account)

Pioneering a Near-Site Clinic: Aircraft Gear Corporation

Catalyst for Payment Reform

Aircraft Gear Corporation reduced health care costs by 20% when they rolled out their near-site . . . clinic to eliminate barriers to primary care. This case study covers the design features Aircraft Gear considered, how they found the right providers, and how they rolled the new program out to their health plan members.

Download the case study (requires free account)

Cost of Care Study

Network for Regional Healthcare Improvement

The Network for Regional Healthcare Improvement (NRHI) explains the relationship between price, . . . utilization and total cost of care, and demonstrates how these factors create health care cost variation across the country.

Read the study

Reference Pricing Action Brief

Catalyst for Payment Reform

Catalyst for Payment Reform provides an overview of Reference-based Pricing: how it works and what . . . it does. The action brief also profiles purchasers who have implemented reference pricing and the outcomes they achieved.

Download the action brief

Additional Background: The Value of Regional Business Coalitions

Catalyst for Payment Reform

As purchasers strive to achieve value in their health care spending, they can look to regional . . . business coalitions for support. Listen to the experts discuss business coalitions, including how they engage in regional health care issues and implement solutions on behalf of their members.

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A Physician’s Perspective On Vertical Integration

The Urban Institute

In this article, Robert Berenson, MD, reviews the existing literature on the quality and cost . . . impacts of vertical integration – the purchase or merging of independent provider practices and hospitals/health systems. Dr. Berenson argues that our laws and regulations should, at the very least, not encourage or incentivize vertical integration, and that structural changes to physician fee schedules are necessary to further reduce incentives for consolidation.

Read the article

Pilot (RAND 1)

RAND Corporation

The first Hospital Price Transparency study commissioned by the Employers’ Forum of Indiana in 2017 . . . which looked at employer claims data for Indiana.

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Trends in High-value Provider Networks

Catalyst for Payment Reform

This virtual event explains how high-value provider networks are established, the incentives . . . consumers need to use them, and provides examples of high-value provider networks that have been implemented by employers. The event also features a dialogue between a consumer advocate and a provider about the pros and cons of high-value networks.

Watch the recording

Price Transparency & Physician Quality Report Card

Altarum’s Center for Payment Innovation & Catalyst for Payment Reform

Altarum’s Center for Payment Innovation (formerly the Health Care Incentives Improvement Institute) . . . and Catalyst for Payment Reform (CPR) published this comprehensive report card on both state health care price transparency and physician quality transparency. Check out how your state performs in both!

Read the 2017 Report

Understanding Market Dynamics

Catalyst for Payment Reform

In the wake of system-wide payment and delivery reforms, the health care ecosystem has grown in . . . complexity, causing health care stakeholders to expand and evolve in response. Listen to CPR’s Suzanne Delbanco provide an overview of the key players in health care, the issue of market power and consolidation among plans and providers, and potential remedial solutions.

Watch the webinar

Telehealth Guide for Purchasers

Catalyst for Payment Reform

The information in this guide is intended for purchasers of health care interested in understanding . . . more about the value of telehealth and how it can be used not only to improve access to and satisfaction with health care for a given population, but also to generate savings and stimulate competition among health care providers.

Download the guide

Research Report: Reference Pricing

The Urban Institute

In this report, the Urban Institute takes a deeper dive into Reference-Based Pricing (RBP). The . . . report summarizes the strengths and weaknesses of the RBP model and describes core design features required for program success.

Download the research report

Virtual Summit: The Quality Measures that Matter

Catalyst for Payment Reform

Virtual summit discussing CPR’s Employer-Purchaser Guide to Quality Measure Selection, which helps . . . purchasers more effectively design, implement and evaluate health care delivery and payment reform programs.

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Case Study: CalPERS Reference-based Pricing Program for Orthopedic Surgery

Health Affairs

Learn how the California Public Employees’ Retirement System (CalPERS) dramatically reduced the . . . total spending and price of certain health care procedures, without measureable differences in quality outcomes, by implementing reference-based pricing.

Read the study