Gloria Sachdev, President and CEO, Employers’ Forum of [email protected]
Chapin White, Senior Policy Researcher, (adjunct) RAND [email protected]
Findings From a National Employer-led Hospital Price Transparency Study
Master Slide Deck for Public Use
Last updated 5-30-19
Rand 2.0 Authors:Chapin White, Ph.D., Senior Policy Researcher, RAND Corp
Christopher Whaley, Ph.D., Policy Researcher, RAND Corp
The contents represent the views of the authors and not the organization or it’s funders
ABOUT THE EMPLOYERS’ FORUM OF INDIANA
Healthcare coalition formed in 2001
Members include self-funded employers, health plans, health systems, and other interested parties
Aim is to improve the value payers and patients receive for their health care expenditures
www.employersforumindiana.org
Members of the Employers’ Forum of Indiana
•Anthem Blue Cross and Blue Shield•AON•American Health Network•Assured Partners•Barnes and Thornburg•Castlight Health•Chrysler (FCA)•Columbus Regional Hospital•Community Health Network•Cummins Inc.•Deaconess Hospital•Eli Lilly and Company•Encore Health•Eskenazi Health•Fort Wayne Community School Corp
•OneAmerica•OneBridge•Ortho Indy•Our Health Inc.•Parkview Health•Purdue University•Roman Catholic Archdiocese of Indianapolis•Roche & Genentech•St. Vincent Health•State of Indiana•Suburban Health Organization•The Henriott Group•Tippecanoe School Corp.•TrueRx•United Healthcare•Young at Heart Pharmacy
•Franciscan Alliance•Gregory & Appel•Healthcare Options•Indiana Farm Bureau•Indiana State Teachers Union•Indiana Health Information Exchange•Indiana Rural Health Association•Indiana University•Indiana University Health•Ivy Tech•JA Benefits•LHD Benefit Advisors•Mercer•Merck (affiliate)•Monarch Beverage•Northwest Radiology
QUESTIONS the Forum Aimed to Answer
Part A:-Are hospital prices high in Indiana?
-How do prices compare among our hospitals?
-Where can we find good value?
-What is our trend?Part B:
-How do our prices compare to those in other states?
Partnership between the Employers’ Forum of Indiana and RAND
FORUM’s Role:
• commission and partner with RAND Corp to conduct Round 1.0, Round 2.0, and Round 3.0 analyses per MOU
• co-develop study design
• co-recruit nationally for study participation
RAND’s Role:
• conduct all study analyses
• prepare study final reports and supplemental material
• co-develop study design
• co-recruit nationally for study participation
Source: White, C., Bond, A. M., & Reschovsky, J. D. (2013). High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power (No. 27).
Retrieved from http://nihcr.org/wp-content/uploads/2015/03/HSC_Research_Brief_No._27.pdf.
Study funded by
the National
Institute for
Health Care
Reform (NIHCR),
using claims data
from automakers
and UAW
BACKGROUND
The Problem: Employer premiums have risen, and so have employee contributions.
7
*Estimate is statistically different from estimates for the previous year shown (p<.05).
SOURCE: KFF Employer Health Benefits Survey, 2018; Kaiser/HRET Survey of Employer-Sponsored Health Benefits. 1999-2017
0.90
0.95
1.00
1.05
1.10
1.15
1.20
2012 2013 2014 2015 2016
Inpatient
Price Utilization and Intensity
0.90
0.95
1.00
1.05
1.10
1.15
1.20
2012 2013 2014 2015 2016
Outpatient
Price Utilization and Intensity
Health Care Cost Institute. (2018). 2016 Health Care Cost and Utilization Report. Retrieved from http://www.healthcostinstitute.org/report/2016-health-care-cost-utilization-report/. Prices are from Appendix Table A3,, utilization and intensity is estimated by dividing spending (from Appendix Table A1) by prices.
Use trending back to baseline.Use trending back to baseline.
QUESTION-PART A: ARE HOSPITAL PRICES HIGH IN INDIANA?PRICE TRANSPARENCY ANALYSIS
• The best method the Forum believed was to convert allowable payments made by employers to what Medicare would have paid for the exact service, thus report relative prices
• For Example: the report shows that employers paid Hospital “A” 200% or 2X on average what Medicare would have paid and Hospital “B” was paid 350% or 3.5X on average what Medicare would have paid
Aim:
To develop a fair method to compare
hospital prices for public reporting
THE RATIONALE FOR USING MEDICARE TO LEVEL SET ALL COMMERCIAL HOSPITAL PAYMENTS
Medicare is the Largest
Health Insurer in the
World
Medicare makes numerous adjustments in price to assure FAIR payments are made to a hospital and their methods are published:
• type & intensity of service/patient acuity
• hospital’s location
• disproportionate share of medically underserved
• medical education provided
RAND 1.0 EMPLOYER HOSPITAL PRICE STUDY: INDIANA ONLY
• Study was funded by RWJF and RAND Corp was contracted to do the study analyses
• Study time period was July 2013 to June 2016
• ~225,000 covered lives in Indiana
• 120 community hospitals in Indiana
• All hospital inpatient and outpatient services
• Total paid claims was $695 million
• Full report of study findings: freely downloadable from RAND’s website: https://www.rand.org/pubs/research_reports/RR2106.html
RAND STUDY 1.0 STUDY FINDINGSIndiana Commercial Hospital Allowable Prices Paid as a Percent of What
Medicare Would Have Paid for the Same Services
Source: White, 2017, Hospital Prices in Indiana.
272%
217% 358%
RAND 1.0 STUDY FINDINGSRelative Prices are Trending Up Away From Medicare
Source: White, 2017, Hospital Prices in Indiana.
QUESTION, PART B: HOW DO INDIANA HOSPITAL PRICES COMPARE TO OTHER STATES?
• Solution: Invite employers across the country to participate in a National Hospital Price Transparency Study, called “RAND 2.0”
•We had a short amount of time to enroll folks in RAND 2.0
•RAND 3.0 study enrollment is ongoing as demand for price transparency is high
AIM: Develop a way to
benchmark hospital prices in Indiana and across U.S. for the first time
Official Study Title: Prices Paid To Hospitals By Private Health Plans Are High Relative To Medicare And Vary Widely-Findings From An Employer-led Transparency Initiative
authored by Chapin White and Christopher Whaley, RAND Corporation
We have created a home page that includes everything about these studies: www.employerPTP.org
• RAND 1.0 and 2.0 National Hospital Price Transparency Report
• Rand 2.0 Supplement Database
• RAND 2.0 Interactive Map Tool
• Master Power Point slide deck which you are welcome to use as you wish
• News/media
• Sign up for RAND 3.0, FAQ and agreements
You may also find the full report and supplement database on the RAND website: https://www.rand.org/pubs/research_reports/RR3033.html
RAND 2.0 Study was Published on May 9, 2019
Our Study Made National & Local News…over 30 News Outlets, including:
• Many Hospitals Charge Double or Even Triple What Medicare Would PayThe New York Times, May 9, 2019
• Study: Employers Pay 240% More Than Medicare For Hospital CareForbes, May 9, 2019
• What Employers Pay Hospitals Varies Widely, Study FindsWall Street Journal, May 9, 2019
• Employer Health Plans Pay Hospitals 241% of What Medicare Would PayModern Healthcare, May 9, 2019
• Private Insurers Paid Hospital 241% of what Medicare Would HaveHealthLeaders, May 9, 2019
• Private Plans Pay Hospital Prices 241% Higher Than Medicare, RAND FindsAJMC, May 9, 2019
• Private Insurers Pay Hospitals 2.4 Times What Medicare PaysBecker’s Hospital Review, May 9, 2019
• Market Muscle: Study Uncovers Differences Between Medicare And Private InsurersKaiser Health News, May 9, 2019
• Study: Indiana hospitals charge private health plans 311% of what Medicare would payIndianapolis Business Journal, May 9, 2019
INTERACTIVE MAP OF US HOSPITAL PRICESemployerptp.org
SUPPLEMENTAL INFORMATION, TABLE 1
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative. Line of service information for inpatient and outpatient services in tables 4 and 5
RAND 2.0 SUPPLEMENTAL STUDY DATABASE FREELY AVAILABLE
Hospital
name
Hospital
Compar
e Star
Number
of
Outpt.
services
Total
Private
Allowed
Outpt. ($
millions
Simulated
Medicare
Outpt.
Relative
price for
Outpt.
Services
Stand.
price per
Outpt.
service
Number
of
Inpt. stays
Total
Private
Allowed
Inpt. ($
millions
Simulated
Medicare
Inpt.
Relative
price for
Inpt.
services
Stand.
price per
Inpt.
stay
Total
Private
Inpt. and
Outpt. (#
millions)
Simulated
Inpt. and
Outpt. ($
millions)
Relative
price for
Inpt. and
Outpt.
services
Parkview
Regional
Medical Center 3 34863 30.1 5.8 515% $353.93 2401 18.1 6.5 280% $17,359 48.2 12.3 392%
Eskenazi Health 4 5494 1.0 .3 332% $249.98 375 2.1 1.3 157% $14,679 3.1 1.6 189%
Indiana
UniversityHealth 3 61214 33.5 7.0 475% $359.29 4431 52.8 21.1 249% $24,954 86.2 28.2 306%
RAND 2.0 National Hospital Price Study of 25 statesConducted by RAND, commissioned by Employers’ Forum of Indiana
20
Services Hospital inpatient, hospital outpatient
States CO, FL, GA, IL, IN, KS, KY, LA, MA, ME, MI, MO, MT, NH, NC, NM, NY, OH, PA, TN, TX, VT, WA, WI, WY
Years 2015-2017
Hospitals 1598 short-stay general medical/surgical
Allowed amount (2015-7)
$12.9 billion in payments ($6.3 billion inpatient, $6.6 billion outpatient)
Claims (2015-7) 330,000 claims inpatient, 14.2 million outpatient line items
Data sources 2 all payer claims databases,many health plans,~45 self-funded employers
Funders RWJF, NIHCR, THFI, self-funded employers (not health plans or hospitals)
Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
OUR APPROACH
Obtain claims data from
-Self-funded employers
-APCDs
-health plans
Measure prices in two ways
-Relative to a Medicare benchmark
-price per casemixweight
Create a publichospital price report
-Will be posted online, freely downloadable
-named facilities and systems
-inpatient prices and outpatient prices
Create privatehospital price reports for self-funded employers
-Optional for
employers
Two Ways Hospital Prices are Measured
1. “Relative prices”
2. “Price per casemix weight”
=𝐴𝑙𝑙𝑜𝑤𝑒𝑑 𝐴𝑚𝑜𝑢𝑛𝑡
𝑆𝑖𝑚𝑢𝑙𝑎𝑡𝑒𝑑 𝑀𝑒𝑑𝑖𝑐𝑎𝑟𝑒 𝐴𝑙𝑙𝑜𝑤𝑒𝑑 𝐴𝑚𝑜𝑢𝑛𝑡
=𝐴𝑙𝑙𝑜𝑤𝑒𝑑 𝐴𝑚𝑜𝑢𝑛𝑡
𝐶𝑎𝑠𝑒𝑚𝑖𝑥 𝑤𝑒𝑖𝑔ℎ𝑡𝑠
adjusted for• casemix• local wages• teaching• uncompensated care
comparable across service lines
adjusted for• casemix
not comparable across service lines
Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Across 25 States: Employer Health Plans Pay Hospitals 241%of What Medicare Would Pay and Overall Trend in Increasing
Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Commercial Relative Price TREND Varies at the State Level: Comparison of 5 States
Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Across 25 States: Average Relative Hospital Prices, 2017Percent Employer Health Plans Pay Hospitals Relative to What Medicare Would Pay
Indiana: TOTAL Hospital Commercial Prices Relative to Medicare, 2017(inpatient plus outpatient)
311%
160%
187% 187% 189%
257% 264% 267% 285% 284% 290% 295% 298% 301% 301%
312% 318%
370%
417%
160%
417%
** RAND 2.0 Study period (2015-2017) averages as study does not provide 2017 relative prices for these two hospitals onlySource: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
311%
Indiana: INPATIENT Commercial Prices Relative to Medicare, 2017
236%
77%
117%
135%
157% 167%
188% 185% 190% 194% 197% 198%
220% 222% 228%
253%
267%
282%
303%
77%
303%
** RAND 2.0 Study period (2015-2017) averages as study does not provide 2017 relative prices for these two hospitals only Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
236%
Indiana: OUTPATIENT Commercial Prices Relative to Medicare, 2017
403%
221% 232%
253%
325% 332% 343%
366% 379% 380%
390% 390% 404% 404% 409% 412%
451%
483%
542%
221%
542%
** RAND 2.0 Study period (2015-2017) averages as study does not provide 2017 relative prices for these two hospitals only Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
403%
Single Health-System: Indiana vs. MichiganTOTAL Relative Inpatient plus Outpatient Prices 2017
284% 299%
312%
155% 145% 146%
%
50%
100%
150%
200%
250%
300%
350%
2015 2016 2017Indiana Michigan
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
INDIANA HEALTH SYSTEMS TREND OF TOTAL COMMERCIAL PRICES RELATIVE TO MEDICARE
28
0%
28
4%
31
4%
34
7%
38
3%
29
4%
29
7%
29
9%
31
9%
35
4%
38
9%
30
2%
29
8%
31
2%
31
8%
37
0%
41
7%
31
1%
F R A N C I S C A N A L L I A N C E A S C E N S I O N H E A L T H I N D I A N A U N I V E R S I T Y H E A L T H C O M M U N I T Y H E A L T H N E T W O R K
P A R K V I E W H E A L T H A L L H O S P I T A L S I N D I A N A
2015 2016 2017
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Our Goal is to Improve Value, Where Value Includes Cost and Quality
BEST Value = High QualityCost
where Cost = Price x Quantity
QUALITY: CMS CREATED PUBLICLY AVAILABLE HOSPITAL COMPARE WEBSITE MEANT FOR CONSUMERS
QUALITY: CMS HOSPITAL COMPAREMEDICARE.GOV
1. Heart attack
2. Heart failure
3. Heart bypass
4. Pneumonia
5. Chronic
Obstructive
Pulmonary
Disease
6. Total knee/hip
replacement
GOAL!
< 150% 150-250% > 250%
Best Quality Using CMS Hospital Star Ratings and BEST PRICE Using RAND 2.0 Study Findings: Across 25 States
Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Takeaway #1: Price transparency is the new normal…Hospital Shopping Should be a Team Sport
Patients
Physicians
Health Plans
Policy Makers
Employers
Takeaway #2: Markets Need Information, Buyers Need Options
• “Chaos behind a veil of secrecy” (Uwe Reinhardt)
• “Where there’s mystery there’s margin”
• We urgently need transparency in both cost and quality:• Prices vary significantly by state
• Prices vary even more so among hospitals within states
• Outpatient prices are more variable than inpatient prices and consume a greater share of the employer’s dollar
• The devil is in the details: you need cost and quality information at the level of the individual provider
Takeaway #3: Commercial Payment Models Do Not Need to be So Complex
How does Medicare pay?
base payment * facility-specific adjustments * casemix + outliers + bonuses: one number comparison of hospital prices!
How do self-funded employers pay?
mix of DRGs, per diems, fixed rates, discounted charges, P4P, shared savings ...
Multiple-of-Medicare contracting
simplifies shopping
bakes in value-based payment (RBB, bundling, pay-for-performance)
stabilizes price trend
States examples: Montana, North Carolina, and Oregon
Takeaway #4: There are Numerous Strategies Available to Drive Value
Benefit Design Levers
can be built on a foundation of contracting
a multiple of Medicare pricing so prices are
comparable
Narrow/Tiered networks
Reference based benefits
Centers of Excellence
Direct employer to hospital contracting
Policy Levers
Prohibit anti-gag clause between carriers and hospitals
Prohibit anti-tiering/-narrow/-tying network contracts
Revise profit/not-for-profit hospital status
Limit/cap on out-of-network charges
THANK YOU!
For The Most Current Information Including Enrolling In RAND 3.0 Study, Please Visit
www.employerPTP.org
EXTRA SLIDES TO BE SHARED IF HELPFUL
MICHIGAN Hospital Systems:Relative Prices (2017) and Operating Margins (2015-17)
-6.7%
8.2% 5.9%
-0.1%
2.2% 4.1% 5.7% 8.0% 7.5% 5.4% 7.5%
-50%
0%
50%
100%
150%
200%
250%
Rela
tive
pri
ce fo
r in
pati
ent a
nd
outp
atie
nt h
ospi
tal c
are
Relative prices Operating margins
Profit Margin information obtained from www.hospitaldatasets.org (: Relative prices are from Operating margins are calculated from Medicare hospital cost report data downloaded
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
MICHIGAN: There Are Good, Moderately Priced HospitalsBest Quality Using CMS Hospital Star Ratings and BEST PRICE Using RAND 2.0 Study Findings
0%
20%
40%
60%
80%
100%
1: Low (<145%) 2: Medium (145-160%)
3: High (>=160%)
Ho
spit
al C
om
pa
re S
tar
Rat
ings
, 20
18
(Sh
are
of
Ho
spit
als
Wit
hin
Pri
ce
Gro
up
)
Hospital Price Group (Relative to Medicare, 2015-7)
5 stars (highest)
4 stars
3 stars
2 stars
1 star (lowest)
Price Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency InitiativeCMS Star Ratings: https://data.medicare.gov/data/hospital-compare
COLORADO: TOTAL Hospital Commercial Prices Relative to Medicare, 2017(inpatient plus outpatient)
269%
159%
196%
246%
274%
311% 314% 319% 319% 320% 327%
ALL HOSPITALS IN
CO TOTALS
INDEPENDENT (CAH)
SCL HEALTH SAN LUIS VALLEY HEALTH
INDEPENDENT (IPPS)
UNIVERSITY OF COLORADO
HEALTH
HCA HEALTHCARE
ADVENTIST HEALTH SYSTEM
BANNER HEALTH
CATHOLIC HEALTH
INITIATIVES
QHR
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
COLORADO: INPATIENT Commercial Prices Relative to Medicare, 2017
221%
125%
174%
193%
228% 233%
240% 246% 250%
260% 266%
ALL HOSPITALS IN
CO INPT
INDEPENDENT (CAH)
SCL HEALTH SAN LUIS VALLEY HEALTH
INDEPENDENT (IPPS)
BANNER HEALTH
UNIVERSITY OF COLORADO
HEALTH
QHR HCA HEALTHCARE
ADVENTIST HEALTH SYSTEM
CATHOLIC HEALTH
INITIATIVES
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
COLORADO: OUTPATIENT Commercial Prices Relative to Medicare, 2017
350%
170%
251%
275%
350%
395% 396% 403% 407%
435% 454%
ALL HOSPITALS IN CO OUTPT
INDEPENDENT (CAH)
SCL HEALTH SAN LUIS VALLEY HEALTH
INDEPENDENT (IPPS)
ADVENTIST HEALTH SYSTEM
BANNER HEALTH
CATHOLIC HEALTH
INITIATIVES
QHR UNIVERSITY OF COLORADO
HEALTH
HCA HEALTHCARE
Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
Volume of Claims per State is Important
• Private Claims Volume in RAND 2.0 Study • Colorado > $ 5 Billion
• Michigan > $ 1 Billion
• Indiana > $1 Billion
• Pennsylvania < $12 million – thus no hospital-specific breakdowns possible
• There’s a wealth of information when sufficient claims are available for analysis.
COMMENTS FROM AMERICAN HOSPITAL ASSOCIATION (AHA)
• Medicare payment covers 87% of hospital cost
• Medicare Payment Advisory Commission (MedPAC)
says hospitals are not efficient because commercial
payment is so high that hospitals do not have the
incentives to be efficient.
➢ 1.0/0.87 = 115% of Medicare is breakeven on hospital
costs so paying a bit more is reasonable.
https://www.aha.org/news/headline/2019-05-09-aha-responds-rand-study-prices-paid-hospitals-private-health-plans
MedPAC report, Marc 2019 http://www.medpac.gov/-documents-/reports
So why are most hospitals…
Losing Money on Medicare?”
“Strong market power leads hospitals to reap higher revenues from private payers. This in turn leads these hospitals to have weaker cost controls. The weaker cost controls lead to higher costs per unit of service. As a result, hospitals have a narrower margin on their Medicare business.”
Jeffrey Stensland, PhDSr. Principal Policy Analyst
Medicare Payment Advisory Committee
48
“Twenty years of wage stagnation on the middle class has been 95% caused by exploding healthcare costs.” - WSJ
March 5th, 2019 National Price Transparency Conference 49
The Health Market Place:
Providing a Failing Value-Proposition
Edging Out Salary Growth & Economic Development
March 5th, 2019 50National Price Transparency Conference
PLANS FOR A NATIONAL HOSPITAL PRICE TRANSPARENCY STUDY, RAND 3.0
• The more states and the more hospitals per state that participate in RAND 3.0, the more valuable it becomes to employers as it helps inform their local strategy towards paying for value
• Cost to participate in the study, 2 options:1. No charge to APCDs or TPAs
2. For employers, who in addition to contributing to the public report, wish to have a PRIVATE employer-level report, the charge is $0.20 per member, with a minimum of $1,000 and a max of $15,000, payable to RAND Corp.
3. No charge for employers who wish to contribute claims data to RAND for the PUBLIC report
RAND 3.0 Study TimelineMonth, Year MilestoneMarch, 2019 Begin recruitment of self-funded employers, APCDs, and health
plansJuly, 2019 Have agreements in place between RAND and employers, DUAs
in place between RAND and health plans/APCDs, and
authorizations sent by self-funded employers to their TPAsOctober, 2019 Data delivery complete
November, 2019 Data testing and analysis, drafting of public report
First Quarter,
2020
Public report finalized and made public online, private employer-
level reports distributed
ACKNOWLEDGEMENTS
• Robert Wood Johnson Foundation
• National Institute for Health Care Reform
• The Health Foundation of Greater Indianapolis, Inc.
• IBM Watson Health
• Economic Alliance for Michigan
• Center for Improving Value in Health Care (CIVHC)
• New Hampshire Comprehensive Health Care Information System
• Colorado Business Group on Health
• Houston Business Coalition on Health
• New Mexico Coalition for Healthcare Value