Health care value is being defined through new payment incentives and value standards proposed and implemented by health care payers, policy-makers, and providers, but has long discounted the inclusion of patient perspective. As part of an effort to advance a “new direction” for the government agency, the Centers for Medicare & Medicaid Servcies (CMS) has issued a Request for Information (RFI) seeking insights on how to better advance innovation in care and payment more representative of patient-centered care as part of the agency’s Innovation Center (CMMI). At the Partnership to Improve Patient Care (PIPC) Annual Forum, Ms. Amy Bassano, the Acting Director of CMMI, explained how CMS might test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.
In an op-ed published in RealClearHealth, PIPC Chairman Tony Coelho examines the limitations of quality-adjusted-life-years (QALYs) and how this tools for value-assessment may systematically discriminate against patients and individuals with disabilities. As he writes, "Underlying all this is the key question we must ask ourselves when considering any policy related to the payment and delivery of health care: for whom are we creating this policy? Who is the ultimate stakeholder? If the answer is not the people served by health systems -- patients and people with disabilities -- then we have a serious problem."
PIPC Chairman Tony Coelho recently penned a blog for HuffPost, complimenting steps that are being taken that show progress in shifting toward value-based healthcare decisions. “While a tremendous amount of work remains to be done, policymakers took two steps recently that show progress is possible. One was approval by the Senate Finance Committee of the CHRONIC Care Act, a bipartisan bill (yes, they still exist!) whose success is attributable to significant stakeholder engagement and that, if enacted, will help to meet real patient needs.”
Chairman's Corner: Patient Voices, Patient Value: Stepping Out of the Ivory Towers into the Real World
In a blog published by The Huffington Post, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho urged members of the new Congress and new administration to listen to real patients and embrace health care solutions for that cater to all patients, caregivers and people with disabilities. "Patients wanted a voice in research and in health care policymaking, because, too often, traditional research is irrelevant to the goals we have for our health and our lives," Coelho wrote. Coehlo also noted that while Congress continues to focus on improving the "value" of healthcare, it is crucial for patients to have a voice in defining this value in their healthcare plans.
In response to Washington Post opinion article, "Keep this part of Obamacare," PIPC Chairman Tony Coelho emphasizes the fact that while the Center for Medicare and Medicaid Innovation (CMMI) appears to be doing "some good work," it is also in serious need of changes to protect patients. "The Innovation Center created significant (if unintended) risks with some models that patients identified as going too far and driving “one-size-fits-all” care in stark contradiction of the nation’s drive to develop targeted therapies under the Precision Medicine Initiative and Cancer Moonshot," Coelho writes. "We all want health care to pay for value and not volume, but the real question is value for whom?"
In an op-ed published in Morning Consult, Lung Cancer Alliance president and CEO Laurie Fenton Ambrose highlights their participation in a recent Open Letter, in which PIPC and over 60 other healthcare stakeholder joined to state that “value” should first and foremost be considered through the eyes of patients and people with disabilities. As she explains, "Every one of us has individual needs, unique characteristics and personal preferences that factor into our health care decisions. We do not fit neatly into one-size-fits-all models and assessments that can drive certain clinical decisions on benefits, cost and effectiveness of treatments," she notes. "That is why we must have a meaningful role in the discussion of value as only we can offer real world input on what matters to us when faced with medical decisions that impact our quality of life."
In an op-ed published in Morning Consult, Donna Cryer, a President and CEO of the Global Liver Institute, a PIPC member, discusses how ICER's payer-focused perspective could harm patients by limiting patient access to medications. "It is unacceptable when payers, instead of patients and providers, use these reports to drive clinical decision-making based on mathematical assessments of so-called 'average value' – although I’ve never met an 'average' patient," she explains. "It is even more frustrating to think that public programs could sidestep patient protections embedded in the Medicare law through a nationwide 'demonstration project' that would allow these assessments to define treatment value."
Inside Health Policy: Senators Raise Concerns With Part B Drug Pay Demo's Size, Effect On Rural Providers
This morning, Inside Health Policy highlighted the ongoing concerns of senators from both parties over the Centers for Medicare and Medicaid Services (CMS) recent proposal on Part B drug payment. The two-part demonstration would adjust the physician reimbursement formula and use value-based pay arrangements in its second phase.
Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho commented as a part of the article, noting that patient groups “stand ready to work with CMS to develop alternative patient-centered approaches, but CMS’ failure to engage patients from day one has resulted in a deeply flawed proposal.” In a statement, Coelho was also quoted as saying, "CMS stirred up such controversy that they really have no choice but to start over and initiate a new more engaged process so patients are with them and not against them on this."
An article posted today in Inside Health Policy outlines the concerns of patient advocacy groups with the proposed use of value-based assessments in the second phase of the Centers for Medicare and Medicaid Services (CMS) Part B drug pay demo. The second phase specifically involves value-based pay arrangements including the use of discounts or elimination of patient cost-sharing; prescribing patterns; and indications-based pricing.
Representatives from various patient groups offered their concerns. Donna Cryer of the Global Liver Institute criticized the use of the Institute for Clinical and Economic Review (ICER) to help determine a value-based payment framework as the Institute has little engagement with patient groups. Patient advocates have also raised concerns with the Institute's methodology.
An article in Healthcare Dive highlights the Partnership to Improve Patient Care (PIPC)'s recent letter to the Centers for Medicare and Medicaid (CMS), which voices their opposition to the agency's Medicare Part B demo. The group expressed concerns over CMS' proposed use of comparative effectiveness research and cost effectiveness as national Medicare standards in phase two of the proposal and urged the agency not to move forward with the proposed rule unless it accommodates people with disabilities.
Libertarian Republic: Proposed Medicare Rule Would Use Metric Banned During Obamacare Death-Panel Debate
An article posted today in The Libertarian Republic highlights the fact that the Centers for Medicare and Medicaid Services' (CMS) recent Medicare Part B demonstration proposal would use a quality-adjusted life years (QALYs) metric for rationing health care, which was banned following the Affordable Care Act (ACA) death-panel debate.
The article also features the concerns of patient advocacy groups, including the Partnership to Improve Patient Care (PIPC), over the demonstration's potential to limit drug access for the elderly and physically disabled. They expressed concern that the QALYs metric fails to take real-life consequences into account - like doctors being pushed toward cheaper yet possible less effective treatment options.
This morning's edition of Politico Pulse highlighted the Partnership to Improve Patient Care's (PIPC) leadership among patient groups in voicing concerns over Phase 2 of the Centers for Medicare and Medicaid Services (CMS) planned Part B demonstration project. PIPC, along with over 40 other groups, are sending a letter to CMS acting administrator Andy Slavitt highlighting issues with the proposed change to lower the add-on payment for drugs in phase 2 of the proposed demo.
An article posted today in The Wall Street Journal outlined lawmakers' concerns with the Centers for Medicare and Medicaid Services' (CMS) recent proposal to reduce Medicare's profit incentives to doctors who administer drugs. WSJ notes bipartisan concerns with the program, including the demands of dozens of House Republicans for the proposal to be withdrawn.
Over the last few years, I’ve been very outspoken on the need to engage patients and people with disabilities in efforts to define the value of health care. Engagement has become my ministry because, frankly, what we often find is “token” engagement - a pat on the head, with no real impact on policy development and implementation. I thought we were making real progress on engagement in this administration. It seems I was wrong.
What's the most important question facing any patient with a life-threatening illness?
"Which treatment option is best for me?"
By most accounts, this is a good problem to have; giving patients a range of treatment options, and the ability to make an informed choice about the regimen that most directly aligns with their personal health priorities is fundamental to high-quality, individualized health care. But along with these new methods for treatment come difficult questions. Do I want the more aggressive or conservative therapy? Is my quality of life during treatment more important than returning to work quickly? Which course of action has more tolerable side effects? Can I afford the care I need?