Purchaser Business Group On Health

TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTH CARE WHILE MODERATING COST.

REDESIGN CARE:PBGH WORKS SIDE-BY-SIDE WITH PHYSICIANS AND OTHER PRACTITIONERS TO: FOSTER INNOVATIVE IDEAS; REDESIGN HOW CARE IS DELIVERED; ALIGN PAYMENT WITH OPTIMAL CARE DESIGN; AND SUPPORT PROVIDERS TO DELIVER OPTIMAL CARE EXPERIENCE AND PRICE. PBGH PROGRAMS INCLUDE: ONES THAT PROVIDE CARE MANAGEMENT FOR HIGH-NEED-COST PATIENTS (THOSE WITH MULTIPLE SERIOUS CHRONIC CONDITIONS); AND PROGRAMS THAT SPREAD BEST PRACTICES FOR COMMON CARE EPISODES (E.G. MATERNITY); PROGRAMS THAT TRAIN PHYSICIANS HIGH-QUALITY, PATIENT-CENTERED CARE, PREVENT PATIENTS FROM RECEIVING DUPLICATE SERVICES, AND REDUCE UNNECESSARY VISITS TO HOSPITALS AND EMERGENCY ROOMS. THE PROGRAMS AIM TO ENGAGE PATIENTS IN THEIR OWN CARE AN APPROACH THAT ACCELERATES PATIENT RECOVERY.

PURCHASER VALUE:PBGH PARTNERS WITH EMPLOYERS WHO PURCHASE HEALTH CARE FOR THEIR EMPLOYEES TO CREATE MEASUREABLE PROGRESS TOWARD A MORE EFFICIENT AND EFFECTIVE HEALTH CARE SYSTEM. PBGH SUPPORTS HEALTH CARE PURCHASERS AND MEMBERS, BY PROVIDING SERVICES INCLUDING: TECHNICAL ASSISTANCE, ACCESS TO NETWORKING OPPORTUNITIES AND PARTNERSHIPS.

INFLUENCE POLICY:PBGH REPRESENTS ITS MEMBER ORGANIZATIONS WITH A STRONG, UNIFIED VOICE IN WASHINGTON BY TESTIFYING IN CONGRESS, COMMUNICATING WITH WHITE HOUSE AND AGENCY STAFF, SERVING ON KEY ADVISORY BODIES, AND PUBLISHING WIDELY THROUGH ISSUE BRIEFS, BLOG POSTINGS AND OP-EDS. PBGH ADVOCACY FOCUSES ON THE "VALUE AGENDA" OF HEALTH REFORM, INCLUDING PAYMENT REFORM AND ALIGNMENT, USE OF MEASURES TO SUPPORT VALUE-PAYMENT SYSTEMS, DATA TRANSPARENCY AND THE FOSTERING OF COMPETITIVE MARKETS.

ACCELERATE TRANSPARENCY:PBGH SUPPORTS CHANGES TO COMMERCIAL PAYMENT MODELS THAT MOVE INCREMENTALLY AWAY FROM FEE-FOR-SERVICE AND TOWARD PAYING FOR VALUE. THESE INCLUDE BUNDLED PAYMENTS FOR MATERNITY CARE, ORTHOPEDIC SURGERIES AND OTHER HIGH-COST AND FREQUENT PROCEDURES. PBGH IS ALSO WORKING TO IMPLEMENT INNOVATIVE PRIMARY CARE CONTRACTING AND QUALITY FOCUSED CONTRACTS WITH ACCOUNTABLE CARE ORGANIZATIONS. THESE PAYMENT MODELS SUPPORT ALIGNED BENEFIT DESIGN CHANGES, SUCH AS REFERENCE PRICING, TIERED NETWORKS AND CENTERS OF EXCELLENCE. AT THE SAME TIME, PBGH IS ENCOURAGING MEDICARE AND OTHER PUBLIC PROGRAMS TO IMPLEMENT ALIGNED PAYMENT METHODOLOGIES SO THAT PROVIDERS RECEIVE CONSISTENT FINANCIAL SIGNALS FROM BOTH PRIVATE AND PUBLIC PURCHASERS.