Negotiating Alliance Services

Large employers and purchasers have long had to rely on intermediaries with conflicting business interests to procure health services and benefits programs. Too often this leads to opaque supplier contracts that add wasteful and unsustainable costs for those paying the bills.

Building on a long history of providing purchasers analytic and technical expertise, PBGH engages with members eager to upend the status quo and bypass traditional actors in the health care ecosystem for independent partners. We support vendor evaluation and selection and bring together subject matter experts and purchasers to share procurement experiences that inform contracting arrangements designed to deliver better care, often at significantly lower cost.

Past work on behalf of large employers and other health care purchasers includes:

• The PBGH Negotiating Alliance, through which purchasers leveraged their collective volume to improve quality and affordability in joint California HMO negotiations for nearly 20 years. Negotiating Alliance initiatives have shaped contracting that has rewarded better provider networks, responded to the needs of the chronically ill and created tools that support consumers’ informed decision-making. Our efforts have resulted in hundreds of millions in cost savings, while improving the care and experience of consumers.
• Health plan assessment and value-based contracting using the eValue8 health plan RFI, adoption of industry-leading performance guarantees and premium benchmarking with risk-adjusted claims analytics.
• Pharmacy benefit procurement through joint purchasing, custom formulary design and industry-leading contract terms to promote rebate transparency, aligned incentives and waste reduction.
• Launched Retiree Health Access with HealthCare Policy Roundtable as a group and individual retiree solution for large employers.
• Assessment of disease management and wellness programs offered by health plans and standalone vendors. PBGH designed pilot programs and audited care coordination and high-cost case management, and the development of standardized contract language and performance guarantees for clinical quality and patient experience.
• Support for data warehouse and analytics vendor procurement processes for diverse organizations, including Health Transformation Alliance and Covered California.
• Evaluation of private exchange products.
• Assessment of EAP and digital mental health vendors.