Collaboration in 2018

Our Theme and Commitment for 2018

The opportunities to make health care work better for all Coloradans – better clinically and more affordably for patients, better financially for purchasers, better professionally and administratively simpler for providers, and better economically for communities – are both numerous and significant.  And, though illusive, they are achievable.  To realize them, CBGH is committed to practicing and supporting unprecedented collaboration on two interrelated challenges:

• Value-Based Purchasing. Today’s health care market hurts our citizens and communities, our schools and our entrepreneurs, and our employers both private and public through its consistent inefficiency, its inconsistent effectiveness, and its increasing (and disproportionate) expense.   These characteristics predictably, even inevitably, result from the often conflicting dynamics of today’s marketplace and the nearly complete opacity with regard to the two components of value: quality and price.  Without commonly adopted measures around quality and in the absence of a reference point on price, purchasers cannot make value-based decisions and the market will not improve in efficiency, effectiveness, or affordability.
• Value-Based Benefit Designs. Over the past two years, CBGH has shown how prices vary much more significantly within networks than across networks – by anywhere from 250% to as much as 1200%.  But we’ve also shown that some services are significantly underused (think prevention and primary care) while other services are significantly overused (see Choosing Wisely) and/or mis-used (see Leapfrog Safety Scores).  Benefit designs that fail to recognize and differentiate these distinct value-based challenges can only serve to cause as many problems as they solve.

 

On both of these counts it is employers who can and must take the lead in fostering, encouraging, accommodating, and even demanding collaboration externally and internally.

• External Collaboration. Employers must bring together their consultant and their plan administrator to move their organization toward common payment methods and performance measures designed to not only align not only with other commercial purchasers, but with Medicaid and Medicare as well.  Several Colorado insurers are already doing this along one dimension: Comprehensive Primary Care  An ever-growing body of purchasers willing to use common approaches for the common good could create the conditions for the kind of market-based solutions Americans pride themselves on.
• Internal Collaboration. Whether fully insured or self-funded, employers essentially purchase healthcare wholesale.  Enrollees are the retail purchasers.  As such, the consistent engagement along with financial incentives for value-based purchasing, through benefit designs, is essential.

 

In short, our theme for 2018 will be the promotion of value-based care (e.g. the right care at the right place at the right price) through value-based purchasing and benefit designs.  And our commitment will be to facilitate and embrace collaboration – in both the governmental and commercial markets – by working with every willing purchaser, consultant, and health plan to engage any willing provider in realizing the opportunities for improvement in health care that will benefit all Coloradans.