THE ROLE OF PRIVATE PURCHASERS IN PAYMENT REFORM Leah Binder, MA, - PowerPoint PPT Presentation

Jul 15, 2023 •432 likes •646 views

1 THE ROLE OF PRIVATE PURCHASERS IN PAYMENT REFORM Leah Binder, MA, MGA, President & CEO, The Leapfrog Group 2 Why the surprising news? 3 4 Surprise Percentage of Covered Workers Enrolled in Either a HDHP/HRA or HSA Qualified

1 THE ROLE OF PRIVATE PURCHASERS IN PAYMENT REFORM Leah Binder, MA, MGA, President & CEO, The Leapfrog Group
2
Why the surprising news?… 3
4 Surprise…
Percentage of Covered Workers Enrolled in Either a HDHP/HRA or HSA ‐ Qualified HDHP, 2006 ‐ 2014 25% 20% 20% 19% 20% 17%* 15% 13%* 10% 8%* 8% 5% 4% 5% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 * Estimate is statistically different from estimate for the previous year shown (p<.05). SOURCE: Kaiser/HRET Survey of Employer ‐ Sponsored Health Benefits, 2006 ‐ 2014.
6 Private Sector Strategies that Improve Quality and Control Costs 6
…And 1 Strategy I Wish For 7
8 1. Extremely Innovative Transparency Tools
Caesars 9
2. Good benefits design strategies 10  Copay waivers (Maine Business Coalition)  Exclusion from deductibles (Fedex)
3.P4P 11
4. Centers of Excellence (Real ones) 12  Lowes, Walmart, Boeing, Pepsi, Honeywell
25%-40%+ unnecessary referrals 13 You read it right  “During my career, I’ve used CSCOEs to reduce the cost per transplant actually performed by about 20 percent and helped companies avoid roughly 40% of transplants altogether.”
5. Reference pricing (Safeway, 2010) 14  Screening Colonoscopy  Range: $900-$7200  Reference: $1,250  No change in utilization  New rules: must show adequate number of providers available accepting reference price (including for ERISA plans)
6. Medical Tourism (Hannaford) 15
Now for that 1 wish… 16
17
Surgical Site Infection 18 $3000 $900 MEDICAID MEDICARE PURCHASERS
19 $39,000 PURCHASERS
Improve Quality, Control Costs 20 The Purchaser Checklist  Transparency tools (including safety)  Benefits design  Pay for performance  Real Centers of Excellence  Reference pricing  Medical Tourism  Safety : All strategies above PLUS track it, report it, demand it, withhold payment, use the Hospital Safety Score
Contact Me 21 Leah Binder President & CEO The Leapfrog Group www.leapfroggroup.org www.hospitalsafetyscore.org Blog: http://www.forbes.com/sites/leahbinder/

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