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Understanding Value-Based Insurance Products in Your Market

How to Tell Which Payment Model is Best for Your Market

Assessing the markets you serve can put you in a better position to understand what payment reform models are likely to work and help you engage in conversations about payment reform with your clients.

Brokers and advisors interested in assessing their markets can use the Market Assessment Tool (MAT) created by Catalyst for Payment Reform (CPR), an independent, non-profit employer coalition pushing for better value in U.S. healthcare. You can read an article about the tool kit on page 16 of the August 2015 edition of Health Insurance Underwriter and access it on CPR’s web site here.

The MAT aims to provide you with a way to identify the characteristics of specific markets, how they may impact options for payment reform, and how they may lead to potential unintended consequences. The tool is a structured seven-step process to assess the interplay of local dynamics (e.g., purchaser activism and innovation and provider organization and consolidation).

If you are interested in conducting a market assessment, you can gain access to the tool kit by contacting Suzanne Delbanco, executive director of CPR, who will walk you through your options, provide access to the elements of the tool as appropriate, and send an end user agreement for your signature.

You can watch a NAHUEF webinar on market assessment here.

Putting Value-Based Products into Action

Knowing what value-based products insurers are offering will help brokers and advisors be part of the growing voice asking for reforms and to stay one step ahead of their clients’ questions. Catalyst for Payment Reform has developed a suite of tools that can help employers and other healthcare purchasers query health plans about their current provider payment practices and plans for future reforms.

From standardized Request for Information questions on payment reform to Model Health Plan Contract Language, CPR’s tools help purchasers create demand for payment innovation. These tools cover four areas.


Standardized health plan request for information (RFI) questions on payment provide a starting point for purchasers to ask health plans about their current provider payment practices. The RFI questions also permit purchasers to monitor the amount of total physician and hospital compensation that is provided in models that are sensitive to provider performance and designed to cut waste.


CPR’s Model Health Plan Contract Language helps healthcare purchasers express their expectations for progress on payment reform through their contracted plans.


Once a health plan relationship is in place, it is important to monitor performance and identify future opportunities to invest in payment reform activities. Checking in with health plans periodically is a necessary step to ensure employers are getting the most from their healthcare dollars.


One way you and your clients can work together to create demand for payment innovation is to form a Health Plan User Group (HPUG). HPUGs bring together plan representatives, employers and healthcare customers on a quarterly basis to track plans’ progress toward paying doctors and hospitals in a more value-oriented way. The HPUG toolkit provides participants with what everything needed to convene and manage the process. CPR’s HPUG Toolkit provides a blueprint for brokers to moderate these forums.

You can watch a NAHUEF webinar on Putting Value-based Products into Action here.