Listening In (With Permission): Conversations About Today's Pressing Health Care Topics

Suzanne Delbanco chats with Zach Brown, PhD, Assistant Professor of Economics at the University of Michigan. Zach Brown analyzed the impact of New Hampshire's price transparency website on health care spending. His research, which was featured in the Wall Street Journal (https://www.wsj.com/articles/one-states-effort-to-publicize-hospital-prices-brings-mixed-results-11561555562), examined spending on medical imagining services using a quasi-experimental approach. The research builds the case that price transparency - when delivered to patients in an easy to understand format - can help lower health care spending. Tune in to learn about the history of price transparency, the arguments for and against transparency, and where more research is needed.

Recorded on February 28, 2020.

Listen in as Suzanne Delbanco speaks with Marilyn Bartlett, CPA, CMA, CFM, Senior Policy Fellow with the National Academy for State Health Policy (NASHP). Prior to joining NASHP, Marilyn served as administrator of the Health Care and Benefits Division for Montana’s state employee health plan. There, she led the successful effort to establish a Medicare Plus contracting strategy, bringing the average price paid to hospitals down to 230% of what Medicare pays, when previous payment levels ranged from 200-600% of Medicare prices. Marilyn examines the factors that helped her bold strategy succeed, including political pressure from the state legislature as well as the absence of large health systems who could more forcibly push back against the purchaser’s strategy. In addition to answering Suzanne’s questions about the effort that landed her a spot in Fortune’s World’s 50 Greatest Leaders list, Marilyn also shares anecdotes from her time as a CFO for a third-party administrator (TPA) and insights on how employers can implement more initiatives like Montana’s.

Suzanne calls Michael Chernew, PhD, director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy at Harvard Medical School. They discuss his December 2019 publication in NEJM Catalyst, “How Different Payment Models Support (or Undermine) a Sustainable Health Care System: Rating the Underlying Incentives and Building a Better Model,” co-authored with Jermaine Heath, AB. The article examines the theory and evidence of fee-for-service, episode-based payments, and population-based payments, and makes recommendations around which payment models can create better incentives. Listen in to get into the weeds on how payment reform works while also staying grounded in a fundamental truth: we can’t expect any Alternative Payment Model (APM) to be successful if the model isn’t sustainable to those who deliver the care.

Can Electronic Health Records (EHRs) help reduce unnecessary health care spending? Suzanne speaks with Scott Weingarten, MD, MPH, consultant to the CEO at Cedars-Sinai and Professor of Medicine, and former Senior Vice President at Cedars-Sinai. Dr. Weingarten's experience implementing EHR reminders across a large health system shows how clinical decision supports embedded into point-of-care settings have the potential to improve clinical outcomes and contain health care spending. Learn how Cedars-Sinai has reduced the number of patients receiving low-value, or even harmful, tests and procedures through this initiative.

Now that EHRs are ubiquitous across the country, the time is ripe to leverage their full potential for quality improvement. Technology advancements like machine learning and natural language processing in EHRs may mean that employers and other health care purchasers have a new ally in reducing wasteful health care spending and improving health care value for their plan members.

Suzanne Delbanco calls Christopher Koller, President of the Milbank Memorial Fund, to discuss top strategies for containing health care cost growth. They discuss the insurance rate review process that Rhode Island enacted during Christopher's tenure as as the state's health insurance commissioner, and how that regulatory process brought down hospital prices for all commercial purchasers. Christopher highlights how opening the black box of commercial prices continues to be necessary to change the health care industry. Suzanne and Christopher explore how today's nearly full employment marketplace is leading to more employers having the courage to stand up to health plans and hospitals to push for affordability.

CPR’s Program Director, Andréa Caballero, calls up MediQuire’s CEO, Emily Chen, to learn why purchasers are choosing to directly contract with providers in order to improve the value of their health care dollars. They discuss what makes a good match between purchasers and health systems seeking to work together, and what challenges self-funded employers and other purchasers may face when pursuing this type of arrangement, such as navigating an array of complex contracting terms. As the head of a data analytics company whose mission is to align payers and providers to focus on the patient, Emily Chen highlights the need for expanded data sharing between purchasers and providers in direct contracts in order to pinpoint the opportunities for improving health outcomes in the purchaser’s population. Emily shares why the direct contracting space is gaining so much momentum among purchasers. She explains that, when direct contracting works well, not only do purchasers and patients win in terms of better health and better value, providers are also poised to win, as direct contracts allow providers to secure a steady stream of patient volume through arrangements that empower their ability to provide population health management while maintaining their bottom line.

Listen in as CPR’s Director of Projects & Research, Julianne McGarry, checks in with Beth Waldman,JD, MPH, Senior Consultant with Bailit Health. Beth Waldman is one of the leading experts in Medicaid delivery system and payment reform design, having served as the Director of Medicaid for the Commonwealth of Massachusetts from 2003-2007 and consulting for a multitude of states and other stakeholders upon joining the Bailit Health team. Since the beginning of 2019, Beth has served as a subject matter expert to guide CPR’s work assembling key contract provisions from the 39 states with Medicaid Managed Care programs to help state Medicaid agencies leverage model contract language.

During the call, Julianne asks Beth to provide a high-level look of the trends in how state Medicaid agencies use their contracts with MCOs to advance payment reform. She also asks Beth to gauge the enthusiasm level of state Medicaid agencies toward the payment reform movement. It's a special time when many providers are finally getting comfortable with certain payment reform methods put forward through programs like State Innovation Models, though it's still to early to know exactly which models are working.

Want to hear more from Beth Waldman? Register for CPR’s Virtual Summit on Tuesday, December 10 where Beth will be speaking on a panel to explore how Medicaid MCO contracting is likely to evolve.

Price transparency is not one-size-fits-all. The optimal price information for a patient is different from the price transparency a physician would find useful and different, too, from what an employer-purchaser needs in order to play it's role in the health care ecosystem.

Suzanne Delbanco calls Chapin White, PhD, Adjunct Senior Policy Researcher at the RAND Corporation to learn about the innovative Employer Hospital Price Transparency project. For this project - now embarking on it's third iteration, Chapin White and Christopher Whaley in conjunction with the Employers Forum of Indiana, analyzed claims data data from 4 million people who received hospital services from 1851 hospitals in more than 20 states. The project garnered attention from major stakeholders, including coverage in the New York Times and Wall Street Journal.

Listen and learn why the Medicare fee schedule provides a standard benchmark that allows employers to see how good - or how bad - they have it as health care purchasers in the metro-areas studied.

How and why are social determinants of health making its way into the Medicaid managed care realm? To find out, Suzanne Delbanco calls Tricia McGinnis, MPP, MPH, Executive Vice President and Chief Program Officer of the Center for Health Care Strategies. The Center's December 2018 report, "Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations," analyzed 40 Medicaid managed care contracts and 25 approved § 1115 demonstrations across the country to analyze the trends in this emerging area of focus. Tricia McGinnis highlights states and health plans with programs and policies in place as well as new approaches to bringing social determinants of health investments to life. Through the Center's work in thinking through health equity, they have found that community-based organizations are well positioned to play an important role in bringing necessary and culturally-tailored support to patients.

Listen in as Mark Fendrick, Director of the University of Michigan Center for Value-Based Insurance Design and a practicing general internist, catches Suzanne Delbanco up on the new developments in the world of Value-Based Insurance Design (VBID). After years of bipartisan support and tireless advocacy, the federal government has made important changes to Medicare Advantage and private health plan programs and regulations to allow more generous coverage of high-value health care services. The greater question is, how can these important changes be implemented without increasing total cost of care for the private employers and public agencies who purchase health care? The answer: VBID X, a model plan that achieves cost-neutrality by specifying reduced or eliminated cost-sharing for high-value services and increased cost-sharing for select low-value services. Building upon a previous episode with Mark from back in July 2017, this is an episode you don't want to miss!