Private/Public Sector Alignment to Drive Value-Based Purchasing
January 2012
Catalyst for Payment Reform Health Plan Request for Information on Payment Reform
In June 2011, the Catalyst for Payment Reform (CPR) developed a Request for Information (RFI) to gather information from health plans for use by employers and other health care purchasers when evaluating health plans for potential contracting decisions. This unique RFI, which CPR plans to integrate into the National Business Coalition on Health's comprehensive RFI eValue8 survey, is designed to help purchasers determine the percentage of compensation tied to value that physicians and hospitals receive from a given health plan. The information also is designed to help purchasers understand how health plans are aligning their business strategies to HHS' Partnership for Patients initiative, what metrics health plans have in place to measure the success of ACOs in providing evidence-based, cost-effective care, and insurers' plans for future payment reform. Overall, CPR's goal is to leverage the momentum created by the Affordable Care Act to motivate purchasers to take the reigns in promoting cost containment and value purchasing in the private sector. A press release further describing the RFI is available here, which includes a link to the RFI itself.
Measures Application Partnership (MAP) Ad Hoc Safety Workgroup Strategy for Public-Private Payer Coordination Strategy
In April 2011, the Measure Applications Partnership (MAP) began its work of pulling together a multi-stakeholder body to provide recommendations to the Secretary of HHS on which quality measures to use in federal programs for accountability, payment and reporting. In response to HHS' announcement of the Partnership for Patients initiative aimed at improving patient safety by 2013, the MAP established an Ad Hoc workgroup to develop a coordinated strategy for using quality measurement to meet the Partnership for Patient goals of reducing preventable readmissions and hospital-acquired conditions. Consumer and purchaser members of the Ad Hoc workgroup have advocated for this strategy to include both public and private sector payers and purchasers. Click here for the workgroup's report, and here for a matrix of the ad hoc workgroup goals and strategies.
American Medical Association Advocates for aligning quality measurement across public sector programs
This document, developed by the American Medical Association and medical specialty societies, presents recommendations for how to align various elements of CMS incentive programs through both short- and long-term strategies. The recommendations are intended to promote harmonized provisions and requirements across and within programs, and to make participation in these programs by practitioners more efficient. The document also identifies and acknowledges the current challenges facing these strategies, while reiterating the big picture goals for why alignment is so critical.
Dissemination of these recommendations has included a direct communication from AMA President Carl Sirio to the chairs of the Measure Applications Partnership (MAP), described above.
Summary of April 28 Meeting Between Private Purchasers and Judiciary Department anti-trust officials
On April 28, 2011, a group of private sector purchasers met with government officials from HHS and the DOJ to discuss how private purchasers and payers can work together to develop VBP strategies without risking anti-trust violations. We have provided a summary of this meeting, which will be used to develop one of the deliverables for this project, the memo on anti-trust guidelines to assist private purchasers.
Trade Regulation Reporter Article: Case Study of a Health Care Vendor With Potential Anti-Trust Violations
This case study from 1993 provides an example of a DOJ business review procedure requested by The Health and Personal Care Distribution Conference, Inc., regarding whether a certain practice of the company was in violation of anti-trust regulation. As per the April 28 meeting described above, DOJ will provide this type of review for any purchaser if requested, in the event that there are concerns about anti-trust violation.
