CHA News

Covered California Releases Report on Health Purchaser Strategies

For CEOs, CFOs, Government Relations Staff

This post has been archived and contains information that may be out of date.

Earlier this week, Covered California released a report — Health Purchaser Strategies for Improving Quality of Care and Delivery System Reform — that reviews in detail the strategies used by health purchasers to drive value in health care.

Key findings include:

  • Mental/behavioral health and substance use disorders were cited as a growing priority among all purchasers. Access is highlighted as the key challenge, but there is limited data or measurement being done.
  • Networks based on value is a high priority item for all purchasers and will continue to be in the future, however finding ways to measure and provide meaningful data is a challenge.
  • Varying efforts are being pursued by purchasers to improve access to primary care — with employers taking more direct control — and health plans using analytics to target outreach while pursuing greater adoption of integrated health models in their networks.
  • Many interviewees associated integrated health care models or accountable care organizations with networks based on value, pointing out value-based networks should incorporate more integrated models to improve health.
  • Although alternative sites of care are not expected to drastically reduce costs, health plans and employers are gravitating towards them to improve the patient experience and enhance access to care.
  • Purchaser concerns in hospital care include safety measures as well as waste related measures related to outpatient utilization such as discretionary emergency department use.

Researchers drew upon interviews with health purchasers representing government entities, large employers, health plans and others, as well as information from certain strategic initiatives and information related to an early version of the Covered California Quality Care and Delivery Reform Framework. This report complements information released earlier this month in a report on quality of care and delivery system reform.