Tools for Purchasers
Catalyst for Payment Reform provides tools to employers and other health care purchasers that they can use to develop and implement high-value health care purchasing strategies, including payment reforms, delivery reforms, and benefit designs.
Tools for Working with Your Health Plan
Request for Information (RFI) Template and Model Contract Language
Health Plan User Groups (HPUG) Toolkit
Payment Reform Check-Up
Would your organization like a stronger voice when it comes to communicating with health plans about your purchasing strategy? The more purchasers that use CPR’s health plan tools, the stronger and more consistent the signal they send to health plans. The CPR Health Plan RFI Questions can be used during the health plan sourcing process to gather and compare information about health plan payment and delivery reform strategies. Similarly, the Model Contract can be used with your organization’s health plan partner(s) to set expectations of the health plan. The HPUG Toolkit and Payment Reform Check-Up can help your organization manage its relationship with its contracted plan(s) by providing questions and information that should be gathered on a regular basis.
Tools for Evaluating Payment Reform
Payment Reform Evaluation Framework
Employer-Purchaser Guide to Quality Measure Selection and Action Brief
Are you not sure if the payment reform programs being used with your population lead to higher-quality, more affordable care? If so, it is critical to conduct a rigorous evaluation, whether your organization gets involved or insists that its health plans perform an evaluation that provides your organization with critical information about the program. CPR’s Payment Reform Evaluation Framework and the Employer-Purchaser Guide to Quality Measure Selection can help your organization get started.
Tools for Supporting Transparency on Health Care Prices and Quality for Consumers
Action Brief on Price Transparency
Comprehensive Specifications for the Evaluation of Transparency Tools
Request for Proposal (RFP) Template for Price Transparency Tools
Report Card on State Price Transparency Laws
How can your organization encourage its population to shop for health care providers and services based on price and quality? For starters, make sure they have adequate access to the information they need. The Action Brief introduces the basics about price transparency and how it can help your organization and its population. The Comprehensive Specifications for the Evaluation of Transparency Tools enables your organization to assess whether the tools offered by health plans or independent vendors will meet your population’s needs. The Model RFP helps your organization source a transparency vendor that meets your needs. The Report Card outlines best practices in transparency and which states are ensuring that citizens have access to price and quality information.
Accountable care organizations (ACO) are the topic du jour, but what is an ACO and what does the ACO movement mean for your organization and population? Learn about ACOs in our Action Brief, and read the Toolkit if your organization is interested in developing an ACO or providing stronger oversight of your health plan(s) ACO strategy. The Toolkit helps purchasers think through ACO contracting options (e.g., health plan administered or direct contract), other key decisions, and how to monitor progress.
Tools for Specialty Pharmacy
Specialty Pharmacy: What Purchasers Need to Know
Is specialty pharmacy a challenging area for your organization and population? This guide outlines a variety of tactics, including payment reform, that purchasers should examine when implementing or expanding a specialty pharmacy management strategy. There is no easy solution to these complex issues, but there are various strategies purchasers can consider to tackle one of health care’s highest-cost areas.
Are your organization’s maternity care costs too high? How are the outcomes for mothers and babies in your population? Purchasers spend significant dollars on maternity care, in part because maternity care practices in the U.S. tend to include excessive and unnecessary interventions, which can lead to poorer outcomes. CPR’s tools can help purchasers work with their health plans to implement strategies that create incentives for providers to adhere to evidence-based practices that improve patient outcomes and help contain unnecessary costs.
Tools for Supporting Reference Pricing
Action Brief on Reference Pricing
Bundled Payment and Reference Pricing: A Match to Change Markets
Curious about reference pricing and how it can be used? The Action Brief describes how reference pricing can engage your population in shopping for health care services and help increase use of high-value (e.g. high-quality, low-cost) providers. Reference pricing also sends a signal to high-priced providers that they may need to lower their prices if they want to maintain patient volume.
Tools for Bundled Payment
How To Guide: Total Joint Replacement Bundled Payment
Action Brief on Bundled Payment
Ever wondered what the advantage of bundled payment is and how it can help move both health care providers and their patients toward better value? CPR’s Action Brief provides the fundamentals on bundled payments. The “How-To Guide” provides a specific approach for total joint replacement and includes tools purchasers can use to implement bundled payment for total joint replacement that can be tailored to reflect specific needs and relationships with plans and providers and to align the incentives of providers and patients.
Is your population experiencing challenges in gaining adequate access to health care? Are you looking for alternative ways to control the utilization of a high-priced health care system? This guide explores how telehealth can fit into a high-value purchasing strategy. It identifies the advantages, limitations, applications, and circumstances in which telehealth can add value.
Tools to Assess Your Market
Market Assessment Tool
Ever wonder which payment and delivery reforms might work best in a specific health care market of interest to you? The Market Assessment Tool provides purchasers and other stakeholders with a detailed way to identify the features of a local market, understand the dynamics of the key stakeholders, and assess how these characteristics may impact options for payment and delivery reforms and related benefit and provider network designs.