Forty Percent of Payment to Physicians and Hospitals in the Commercial Sector Today is Designed to Improve Quality and Reduce Waste

Catalyst for Payment Reform (CPR) today released the 2014 National Scorecard on Payment Reform. The 2014 version of this annual Scorecard indicates commercial health plans have dramatically shifted how they pay physicians and hospitals, with 40 percent of their payment now designed to encourage health care providers to deliver higher-quality and, in some cases, more affordable care.

The National Scorecard on Payment Reform uses data submitted by commercial health plans on a voluntary, self-reported basis to eValue8, the National Business Coalition on Health’s annual request for information to health plans. The plans responding to the Scorecard questions represent 65 percent of the commercially-insured lives in the U.S.

You can read more about the 2014 Scorecard here and access the complete Scorecard online.

New Report Card on State Price Transparency Laws, Regulations, and Websites Released

Forty-five states received a failing grade, only two received a B (Maine and Massachusetts), and no states earned an A, according to the second annual Report Card on State Price Transparency Laws developed by Catalyst for Payment Reform (CPR) and Health Care Incentives Improvement Institute (HCI3). The Report Card offers policymakers, consumer advocates, and other health care stakeholders a comprehensive state-by-state resource on consumer access to price information for health services. The grades are lower than in 2013 as this year’s Report Card no longer graded states only on the laws they have adopted to promote price transparency, but also on states’ price transparency regulations, price transparency websites (to the extent they exist), and all payer claims databases – the ideal source of data for these websites because they contain more accurate, complete price information. States that relied on all-payer claims databases as the source of price information for consumers received higher grades, as did states with adequate, fully operational, consumer friendly websites (mandated by law).

Some states have robust price transparency laws and regulations on the books, requiring them to create a publicly available website – but often the public can’t readily access price information because the website is poorly designed, or inadequately functioning. As an example, New Hampshire – a state that received an A in last year’s Report Card – received an F this year, because its website is inoperative and may remain so for an extended period.

To get a high score, a state needed to have both the “spirit of the law” – public access to a fully functioning website, and the “letter of the law” – robust legislation and regulations on the books ensuring the price information would remain accessible.

You can view the full report card here.

New Case Study Examines South Carolina's Initiative to Improve Birth Outcomes

A new case study released by Catalyst for Payment Reform (CPR) with support from the Milbank Memorial Fund shares the story of South Carolina’s Birth Outcomes Initiative (BOI). The case study chronicles how South Carolina’s Department of Health and Human Services, South Carolina’s largest commercial health plan, and many other stakeholders partnered to engage providers in quality improvement activities, and then agreed together to stop paying for early elective deliveries—those occurring before 39 weeks gestation. Early elective deliveries are associated with worse health outcomes for infants and mothers and higher health care costs. Despite the overwhelming evidence against early elective deliveries, an estimated 10 to 15 percent of babies in the U.S. continue to be delivered early without medical cause.

The South Carolina BOI has so far reduced unwarranted early-elective inductions by 50 percent, decreased neonatal intensive care unit admissions, and saved the State’s Department of Health and Human Services more than $6 million (in just the first quarter of 2013). South Carolina is the first state in the nation in which the Medicaid agency and the largest commercial insurer have collaborated to establish a policy of nonpayment for early elective deliveries.

New CPR-HCI3 Paper Examines the Power of Coupling Reference Pricing With Bundled Payment

Pairing reference pricing and bundled payment together can be a potent strategy for purchasers and plans to reduce health care costs, while providing the right incentives and high-quality care to employees and members. Check out the new paper from Catalyst for Payment Reform and the Health Care Incentives Improvement Institute (HCI3) that details how to combine these two for maximum value.

New White Paper on VBID and Transparency

The Catalyst for Payment Reform (CPR) and the V-BID Center at the University of Michigan released a joint white paper examining obstacles to quality and price transparency. The paper highlights ways to motivate consumers to shop for care based on value and focusing on initiatives that meld consumer incentives with greater price transparency. The paper examines several successful models, including some used by CPR members, CalPERS, Group Insurance Commission of Massachusetts, Pitney Bowes, and Safeway, Inc. These initiatives include reference and value pricing, tiered and narrow networks, centers of excellence contracting, and value-based insurance design. Blending quality and price transparency with evidence-based consumer incentives can lead to an increase in the use of higher-value care and clinically appropriate services delivered in the most appropriate venue. In turn, this should also lead to a decrease in inappropriate and potentially harmful medical expenditures.

CPR Webinar on Payment Reform Tools

On September 30th at 11:00 am PT, NBCH member coalitions and employers are invited to join Catalyst for Payment Reform (CPR) for a one hour webinar to learn more about CPR's tools to help purchasers drive payment reform, including our health plan request for information (RFI) and health plan model contract language. RSVP to nperelman@catalyzepaymentreform.org.

CPR Urges Plans, Providers to Add Their Payment Reform Programs to Their National Compendium

A close collaborator of NBCH, Catalyst for Payment Reform (CPR) has launched a National Compendium on Payment Reform This is a brand new searchable and sortable website designed to catalogue payment reform efforts underway across the country. Those implementing payment reforms are encouraged to share a description of their efforts in the compendium, a resource for health care purchasers, payers, providers, policymakers, researchers, and journalists. Visit the website and register to upload information about your payment reform pilot or program.

CPR is offering one hour of free consulting to the first ten organizations that add their program! Add your entry today!

Consumer-Purchaser Disclosure Project Webinar on Price Transparency

Price transparency is essential to empowering consumers to shop for higher value health care. Yet comprehensive price information is sorely lacking most of the time. Public policy and private initiatives can play critical roles in advancing price transparency. The Consumer-Purchaser Disclosure Project will host a webinar with the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute on this topic. We will share what has been happening in the public and private sectors and discuss opportunities for improving price transparency.

Please join us on April 8th from 1-2:30 pm EDT. To register for the webinar, click here.

Catalyst for Payment Reform Releases National Scorecard on Payment Reform

Catalyst for Payment Reform (CPR), an independent, non-profit employer coalition pushing for better value in health care, today released its first National Scorecard on Payment Reform. The Scorecard shows that only about 11 percent of the health care dollars we pay to doctors and hospitals today are value-oriented -- tied to how well they deliver care or create incentives for both improving quality and reducing waste. Almost 90 percent of payments reported remain in traditional fee-for-service, paying providers for every test and procedure they perform regardless of necessity or outcome, or in bundled, capitated, or partially-capitated payments without quality incentives.

Within the 11 percent of payment that is value-oriented, the Scorecard finds that 43 percent of those payments give providers financial incentives by offering a potential bonus or added payment to support higher quality care, such as fee-for-service with shared savings. The other 57 percent of payments put providers at financial risk for their performance if they do not meet certain quality and cost goals, such as bundled payment.

The National Scorecard on Payment Reform uses data submitted on a voluntary, self-reported basis to eValue8, the National Business Coalition on Health’s annual Request for Information to health plans. The plans responding to the Scorecard questions represent almost half of the commercially-insured lives in the U.S. While Scorecard findings are not wholly representative of health plans across the U.S., they offer a preliminary baseline against which to measure progress toward value-oriented payment in the commercial sector.

New transparency report card; states must step up to help consumers gain access to health care prices

Consumers have information readily available on the quality and prices of restaurants, cars and household appliances, but not for health care options. While we’ve made some progress, shockingly little information still exists about health care prices, even for the most basic services. Several studies have shown that the price for an identical procedure can vary as much as 700% with no difference in quality, and with health care comprising 18% of the U.S. economy and costs rising daily, it’s troubling that most prices are still a mystery.

The Catalyst for Payment Reform (CPR) and the Health Care Incentives Improvement Institute (HCI3) have been pushing health plans and providers to share price information more freely and are seeing progress. But public policy—or even just pending legislation—can provide a powerful motivator as well.

Today CPR and HCI3 have released a new Report Card on State Price Transparency Laws. The report shows that most states are not doing their part to help consumers be informed and empowered to shop for higher value care. The report find that 72 percent of states failed, receiving a “D” or an “F,” and only two receive an “A.”

New Catalyst for Payment Reform Resources

The Catalyst for Payment Reform (CPR) has published three new resources on price transparency: a Statement by CPR Purchasers on Price and Quality Transparency in Health Care, a new CPR Action Brief on Price Transparency– An Essential Building Block for a High-Value, Sustainable Health Care System, and CPR’s Comprehensive Specifications for the Evaluation of Transparency Tools. We have linked these three new documents on our NBCH Health Policy webpage. We encourage you to use and distribute these resources to your members and partner organizations.  

CPR Embarking on Project to Track Nation’s Progress on Payment Reform

With funding from The Commonwealth Fund and the California HealthCare Foundation, Catalyst for Payment Reform (CPR) has launched a project to track the nation’s progress on payment reform.


CPR convened an Advisory Committee whose members are providing expert advice and a myriad of perspectives as CPR develops a National Scorecard on Payment Reform and a National Compendium on Payment Reform. The Scorecard will track the status of the private sector’s progress from volume- to value-oriented payment on a national and regional perspective. The Compendium will be a web-based, searchable and sortable, detailed database of private-sector payment reform initiatives across the country. Together, the Scorecard and Compendium aim to catalyze action toward payment reform by illustrating and monitoring where the country stands in its effort to move toward value-oriented payment. Both are scheduled to be released at the end of the first quarter of 2013.


For more information about CPR’s National Scorecard on Payment Reform and National Compendium on Payment Reform click here.

Catalyst for Payment Reform releases model contract for employers

The Catalyst for Payment Reform released a tool to unite employers and other health care purchasers around the shared goal to make 20% of health care payments based on value by 2020. This tool should help coalitions with their efforts to reform payment in their communities.

The model contract highlights immediate opportunities to reform how health plans pay doctors and hospitals. Together with CPR’s health plan RFI (request for information) questions on payment reform, which purchasers use for selecting health plans, the contract language outlines bold purchaser expectations for progress on payment reform by their contracted plans or third party administrators. Expectations include advancement toward: value-oriented payment; quality and price transparency; comprehensive consumer decision-support tools; and monitoring of the level of competition among providers.

The CPR RFI references eValue8. NBCH and CPR have been collaborating since 2010 to synchronize as much as possible the information being asked of plans around payment reform. Some of the questions in the CPR RFI were in eValue8 2011. Since then we have worked together and with an outside consultant to refine the questions; gathering feedback from the plans in August last year for inclusion in eValue8 2012.

Additional information from CPR can be found here.

Catalyst for Payment Reform provides purchasers with maternity care payment resources

Labor and delivery account for nearly a quarter of all hospitalizations for many employers, and costs associated with pregnancy and its complications are a driving factor in the rising costs of health care. Cesarean deliveries, elective labor inductions and scheduled deliveries before 39 weeks are also the rise. The growing use of medically unnecessary interventions is increasing costs and the incidence of complications among mothers and babies, with no evidence of improved outcomes.

There are a variety of payment alternatives that can align incentives for providers and hospitals to adhere to evidence-based practices that improve outcomes for both infants and mothers and decrease the growth in health care spending for maternity care services. CPR has put together an Action Brief for health care purchasers that provides both an overview of the payment reform opportunity and steps purchasers can take to begin implementation.

NEW CPR Action Brief

Most of us would like to revamp the way we pay doctors and hospitals entirely. But changing payment won’t happen overnight. In fact, while we work to innovate with new forms of payment, we will be living with the existing payment system, including fee-for-service (FFS), for quite some time. So, it pays to ask: “How can we improve it?”

Today, Catalyst for Payment Reform (CPR) released an action brief on reforms that seek to counter some of the perverse incentives rooted in our current approaches to payment. While these reforms are less far-reaching than bundled or global payment, they can reduce costs and increase value in the short term. Read more...