At Catalyst for Payment Reform, we are fortunate to work with some of the country’s most innovative employers and other healthcare buyers. Year after year, these visionaries attempt to tackle the major fundamental issues plaguing the country’s health system through service and network design strategies, payment and delivery reforms, and price transparency.
By leading by example to others and sharing the lessons they have learned and their best practices, these innovators inspire a wave of others to follow their example. The strategies they employ serve as a crystal ball through which we can identify potential future trends. As we move into 2022, here are some of the most recent and remarkable buying strategies implemented by our nation’s most forward-thinking healthcare buyers.
Eliminate an expensive supplier from a network
32BJ Health Fund, a multi-employer labor trust fund that provides benefits to 190,000 people, many of whom are in the New York area, announced in June that it would remove an expensive provider, the New York Presbyterian, from its network. , January 1, 2022. This news may indicate that for some employer-buyers, high healthcare prices have created a tipping point and more buyers will adopt narrow networks, high-performance networks, or exclude a particular supplier from high price of the network. .
Partnering with a third-party administrator who shapes the market
Equity Healthcare, which buys healthcare for Blackstone’s portfolio companies, will deliver benefits through Centivo, a new third-party administrator (TPA) focused on value-based care, effective January 1, 2022. In recent years, an increasing number of TPAs offering various business models and value propositions have come into direct competition with health plans for self-insured buyers.
Offer virtual care via a direct contractual partner
General Motors caused a stir a few years ago by launching a direct contract with Henry Ford Health System (HFHS). The automaker has since expanded that arrangement, opening a virtual care center operated by HFHS staff at its global technical center in Warren, Michigan. With the COVID-19 pandemic, the use of virtual care has skyrocketed and remains above pre-pandemic levels while health plans are even starting to offer virtual plans.
Bet Bigger on Episode Based Payouts
For years, Washington State’s largest buyer, the Washington State Health Care Authority (HCA), has implemented transformational strategies such as a responsible care program and pooled payment for joint replacements and The Spine Merger on behalf of its plan participants, which include public sector employees, school employees, retirees and their eligible dependents.
Beginning in January 2022, HCA will participate in Regence Blue Shield’s Episodes of Care program, offering coordinated care and payment per episode for orthopedic procedures, cardiac procedures, gastrointestinal disorders and maternity care. Regence has partnered with Signify Health, a company that administers episode-based payments to healthcare providers, to operate the program. Episode-based payment is a promising fee-for-service alternative, but has yet to reach scale in the United States
Advancing maternity care by piloting doula coverage
Walmart, the country’s largest private employer, aims to improve maternity care and announced a pilot project in Georgia to improve access to doulas. Doulas provide education and support to pregnant women during pregnancy and during labor. This is good news, as CPR has seen limited progress in improving the quality of maternity care, including the consistently high rate of Caesarean sections. Limited progress has also been made in implementing strong incentives for providers to follow maternity care guidelines.
Will more employers and other buyers eliminate high-cost providers from their networks and / or adopt high-performance networks? Will suppliers increasingly accept bulk payment? Will the nation turn the corner of its catastrophic record on maternity care outcomes? Only the crystal ball knows the answers. But with these buyers in mind, 2025 and beyond is shaping up to be brighter.
Ryan olmstead is Director of Member Services for Catalyst for Payment Reform.