Our Work

What are examples of current and past work?

Since its inception, NHPGH has been very active in New Hampshire’s healthcare landscape. Examples of past work include:

• Developing communications strategies to support employers in educating employees on concepts such as cost variation, the lack of correlation between cost and quality, using the right care at the right time, and other consumerism topics;  
• Convening leaders from hospitals involved in proposed acquisitions to inquire about plans for system mergers, access to care, cost of care, and community impact;
• Partnering with the Department of Justice Charitable Trust Unit to develop recommendations for oversight and community investment as part of healthcare  acquisitions, which led to formal regulatory change;
• Convening national experts on Centers of Excellence and provided trend forecasting on moving outpatient procedures from hospitals to ambulatory surgical centers;
• Convening national data experts to better understand claims analysis, NASHP’s Hospital Cost Tool, and RAND reports;
• Convening national experts to discuss transparency in working with pharmacy benefit managers, and trends in coverage for weight loss drugs and cell and gene therapies;
• Monitoring, analyzing, and providing guidance on COVID policies, laws, and emergency orders during pandemic;
• Engaging with hospitals and ambulatory surgical centers annually to encourage participation in the Leapfrog Hospital Survey and Leapfrog Ambulatory Surgical Centers Survey;
• Affiliating with the Leapfrog Group and National Alliance of Healthcare Purchaser Coalitions to participate in national conversations around healthcare quality and transparency, benefits design, cost containment, and more.

What are examples of potential future work?

The rising price of healthcare, not utilization, is responsible for most medical and pharmacy claims spending.[i] Through augmented collaboration with more employer members, New Hampshire employers could more positively impact the cost of and access to healthcare in the state. Some examples include:

Prioritizing Primary Care

Primary care accounts for approximately 6% of all healthcare claims in NH.[ii] Adults who regularly see a primary care physician have 33% lower healthcare costs. The United States could save $67 billion each year if everyone used a primary care provider as their principal source of care.[iii] Employers have been successful in shifting expenditures through utilization of patient-centered medical homes or advanced primary care. Other strategies can include investing in the primary care workforce to improve access to care, as well as educating patients about the importance of primary care. Some states, such as Virginia, New York, and Massachusetts have developed a primary care scorecard. Other states, such as Virginia, New York, and Rhode Island have established a state coalition in primary care.  The Virginia Center for Health Innovation, in partnership with Milbank Memorial Fund, has developed a Primary Care State-Federal Alignment Tool to support other states in their own primary care initiatives. Many primary care approaches can be implemented by employers without legislation.

Promoting High-Value, Cost-Effective Care

Hospital care comprises 40% of healthcare spending in NH.[iv] By engaging in conversations about the importance of transparency in pricing and quality information, employers would have the information they need to steer employees to high-value, cost-effective care. The United States could save $55 million each year using this practice.[v] Approaches can include accountable care organizations, bundled payments, Centers of Excellence, narrow networks, reference-based pricing, and more. Many of these approaches can be implemented by employers without legislation.

Driving Down Prescription Drug Costs

Over the past decade, the cost of prescription drugs has increased three times faster than the rate of inflation. High prescription drug costs continue to bankrupt families and put financial strain on businesses. Pharmacy benefit management plays a significant role. By learning to navigate relationships with pharmacy benefit managers, employers can strengthen their negotiating and contracting abilities. Federal and state legislation has been introduced to rein in costs over the past few years, but employers can implement strategies on their own as well. The National Alliance of Healthcare Purchaser Coalitions and other regional coalitions have drafted  playbooks with step-by-step guidance.

Banning Anti-Competitive Contracting in Healthcare

In many markets, providers or insurance carriers have negotiating leverage that enables them to require contract terms that can be considered anti-competitive, because the effect is to limit competition and thus limits downward pressure on prices. Twenty states have impacted contracting through legislation, including banning "all or nothing" contract provisions, banning gag clauses around provider prices, banning "most favored nation" clauses, and enacting anti-tiering legislation.

Regulating Hospital Facility Fees

“Facility fees” are any fee charged or billed by a healthcare provider for outpatient services provided in a hospital-based facility that are separate and distinct from the professional fee. Adding facility fees has created an incentive for health systems to acquire physician practices. In addition to being able to govern more referrals to their inpatient facilities, they can tack on a facility fee to each service delivered by physicians. Medicare has had some success in eliminating many of these fees through policy change. Some states - Washington, Minnesota, and Texas - have had success in requiring transparency in facility fees. Other states - Connecticut, Colorado, New York, Texas, Ohio, and Washington have prohibited and limited fees. 

Implementing All-Payer Rate Setting

Through all-payer rate setting, the state establishes its own singular fee schedule that applies not only to commercial prices, but also to Medicare and Medicaid. This can help level the playing field between public and private carriers, and lead to competition on efficiency, care quality, and care experience. There is also a health equity benefit with respect to access to care. If providers receive the same revenue from all payers, they have no financial incentive to privilege or prioritize patients based on health insurance, or lack thereof. Maryland is the only state with all-payer rate setting.

Establishing a Cost-Growth Benchmark

A cost-growth benchmark is a statewide healthcare spending target against which a state can monitor its healthcare spending. It limits how much a state's healthcare spending can increase each year. Massachusetts was the first state to attempt this approach and other states - California, Connecticut, Delaware, New Jersey, Oregon, Rhode Island, Washington, Maryland, and Vermont - have followed.