1. PIPC Chairman Coelho in Morning Consult: ‘Value: Just Ask The Patient’, click here to view the op-ed.
2. Save the Date: PIPC’s 6th Annual Forum on December 3rd, click here for details, and email annika@PIPCpatients.org to RSVP.
3. PIPC Submits Comments on LAN APM Framework Draft White Paper, click here to view the comment letter.
4. LAN Webinar: Building a Patient-Centered Health System, click here to register for the webinar.
5. In Comments to CMS, AAHD/Lakeshore Foundation Endorses PIPC’s MACRA Comments, click here to view the comments.
6. KHN: Researchers Say Their Path To Better Health Starts With Patients’ Input, click here to view the article.
Many people want to quantify “value” in health care. But for the ultimate beneficiary, the patient, value is more personal. That doesn’t mean we can’t get better value, it just requires us to find ways that respect patients and their diverse care needs and preferences. This was the big message I took away from a roundtable recently convened by the Partnership to Improve Patient Care (PIPC) and the Cancer Support Community (CSC) with many leading organizations representing cancer patients.
We quickly agreed that there is no one algorithm or formula for value. As a result, our discussion focused on concrete policies that could consistently achieve outcomes that matter to patients, while recognizing those outcomes will vary considerably from one cancer patient to the next.
A few key recommendations emerged from the discussion. First is the importance of patient engagement. The time is now to bring patients into the conversation about policies impacting patient access to care in the Medicare program and beyond. Patients share the goals articulated by policymakers to improve quality, lower costs and improve the patient experience. But, meaningful patient engagement in pursuit of these goals will require a strong commitment from policymakers – not just checking the box. Patients must be involved in the development of new models of care at the outset, and their success should be measured by their impact on patients. The Centers for Medicare and Medicaid Innovation (CMMI), which has broad authority to test Medicare and Medicaid policy, should hold contracted APM’s accountable for measurable impact from their beneficiary engagement activities, including patients and people with disabilities and their families.
A second recommendation supports shared decision-making and the care planning process. Patients view APM’s as a critical opportunity to advance shared decision-making. Congress recognized in statute the need for shared decision-making tools to support achieving outcomes that matter to patients as part of new APM’s. Yet there is little incentive in the payment system to use them. Nor are they well-defined. A care planning process that captures patient preferences and changing treatment goals over time (imagine the difference between a cancer patient’s goals at diagnosis versus at later stages) is needed to support meaningful shared decision-making between patients and their providers. In health care, there may be more than one “effective” choice, but only one that suits the patient’s quality of life considerations. At our roundtable, I was particularly struck by a statement from one participant that there is a big difference between “surviving” and “living;” the latter being a primary goal for many struck with disease. Patients would be eager to lead a process to identify essential elements of patient-centered care planning and shared decision-making that could be implemented and incentivized through APMs.
Third is quality measurement. APM’s such as CMMI’s Oncology Care Model are creating the need for more patient-focused measures to assess quality and balance cost-containment incentives. Traditional quality measures often assess processes of care, and others measure clinical outcomes such as overall survival. However, for APMs to reflect value to the patient, measures that assess patient-reported outcomes, quality of life, and patient engagement must be developed and advanced. Cancer-focused patient organizations can and should be partners in these efforts.
Lastly, patients want transparency and accountability. Most patients are not even aware of the transition to value-based payment and its major implications for patient care. Try asking a Medicare patient if they are aware of a clinical pathway for their oncology care, or if they are enrolled in an accountable care organization. I bet you’ll get a blank stare. Until recently, development of APM’s has occurred in a black box. Within the last year, CMMI has begun to seek external input into new models laying the framework for Medicare’s future. Still, many questions about their significant impact on patients’ treatment choices, such as the Oncology Care Model, remain unanswered. The majority of the communication about these initiatives occurs between payers, Medicare, and participating providers. Therefore, CMMI should adopt a more open and accountable process for developing and evaluating payment demonstrations, while directly inviting feedback from impacted patients about the potential or real impact on care delivery.
It has been big news lately that the Centers for Medicare and Medicaid Services (CMS) created the Health Care Payment and Learning Action Network (LAN) to advance new models of payment and care delivery. The payers that have the most to gain from payment reforms are a loud voice in the LAN’s work. Patients have stepped forward to advance the creation of a LAN Consumer and Patient Affinity Workgroup to ensure that APM’s serve patient needs without putting undue restrictions on access. The role of the Consumer and Patient Affinity Workgroup will be a strong indication of whether success of new payment and care delivery models is to be based on outcomes that matter to patients. Beyond this workgroup, better and more targeted methods to get patient input, such as those suggested by oncology patient groups, are needed to ensure that existing APM’s, both those in the development process and those underway, meet the bar of being patient-centered.
The approach that emerged from our forum – one that advances value for all patients while respecting differences in values among patients – is diametrically opposed to renewed calls for policy-making grounded in centralized value judgments and cost-effectiveness thresholds. Instead, achieving personalized or precision medicine requires systematic goals to achieve outcomes that matter to the individual patient, as opposed to treating “averages.” There would in fact be significant costs, both for the healthcare system and for my quality of life, if I were treated as an “average” epilepsy patient – more seizures, hospitalizations, and doctor visits, in addition to the stresses of my recovery.
Our healthcare system will never know how to measure and reward quality if we don’t ask patients what they value. Patients are ready to move towards better value, but to get there, you need to put us in the driver’s seat.
Click here to view the op-ed.
2. Save the Date: PIPC’s 6th Annual Forum on December 3rd
On Thursday, December 3rd, the Partnership to Improve Patient Care (PIPC) will hold our 6th annual forum entitled, "CER in the Real World: The Value of Patient-Centered Outcomes Research." Does the term “patient-centered” sound familiar? Patient-centeredness begins with the development of evidence that patients can use to support improved health decision-making, often including a special type of comparative effectiveness research known now as patient-centered outcomes research. Policymakers, payers and advocates often use terms like patient-centeredness, patient engagement, and patient empowerment. Yet, just using the right terminology does not necessarily indicate a policy that achieves outcomes that matter to patients. Join PIPC for a discussion about the creation of the Patient-Centered Outcomes Research Institute and its implications for achieving outcomes that matter to patients. Click here for details, and email annika@PIPCpatients.org to RSVP.
3. PIPC Submits Comments on LAN APM Framework Draft White Paper
Last week, the Partnership to Improve Patient Care (PIPC) submitted comments on the Alternative Payment Model (APM) Framework Draft White Paper composed by the Health Care Payment and Learning Action Network (LAN).
In their comments, the Partnership expressed its belief that a few foundational elements must be in place for an APM framework to be successful. First, new payment models must have the tools to appropriately risk adjust so that bundled, population-based or capitated payment models do not inappropriately restrict access to care for chronically ill and disabled patients. Second, quality measures must be developed and implemented that capture outcomes that matter to patients so that “quality” and “value” are based on patient needs, preferences and outcomes. Third, decision aids must exist and be used that provide patients with unbiased access to their treatment options and the impacts of those treatments on outcomes that matter to patients so that shared decision-making is meaningful. Lastly, a constant feedback loop must exist to identify in real time the impact of new payment models on access to care, particularly for vulnerable populations.
On the issue of quality, the Partnership agreed with the white paper’s assessment that quality indicates that patients receive appropriate and timely care that is consistent with evidence-based guidelines and patient goals, and that often generates positive patient outcomes. At the same time, it is important to prioritize the measures to which providers are held accountable so that they truly reflect outcomes that matter patients and do not place undue administrative burdens on providers. The Partnership believes patients and providers should be at the forefront of this process.
Overall, the Partnership is concerned about the pace at which alternative payment models are being promoted and expanded, potentially in the absence of appropriate risk adjusters, quality measures, decision aids, and feedback loops. We urge a strong focus on developing this foundation in order to thoughtfully advance alternative payment models that achieve outcomes that matter to patients.
In furtherance of this goal, PIPC provides the following broad recommendations for payment and delivery of healthcare.
- Provide a meaningful voice to patients. Policymakers should establish formalized mechanisms that provide a meaningful voice to patients throughout the healthcare system.
- Prioritize policies that promote patient-centeredness and ensure new payment and delivery models do not define success as simply meeting financial targets or promote a “one-size-fits all” approach to cost-containment.
- Catalyze the development and endorsement of meaningful quality measures and ensure they are appropriately incentivized in health systems. Policymakers should recognize the need to improve the patient-centered infrastructure for measuring and rewarding improved health outcomes. There are significant gaps in quality measurement that will require expanded support for measure development and endorsement.
- Foster informed choices from the range of clinical care options through shared decision-making, transparency of the incentives (financial and otherwise) that drive care decisions, and by empowering patients with accessible, understandable evidence.
- Support patient access to high quality individualized care.
Click here to view the comment letter.
4. LAN Webinar: Building a Patient-Centered Health System
On Wednesday, December 2, the Healthcare Payment Learning and Action Network (LAN) wil hold a webinar “to learn how to engage patients in alternative payment models (APMs). Guiding Committee co-chair Mark Smith will share key progress updates from the Guiding Committee and the three LAN work groups. During the webinar panel, presenters will outline strategies to engage patients and family caregivers in APMs. Panelists will share several approaches and discuss how patients can serve as partners in building a patient-centered health system. The panel includes moderator Alan Balch of the Patient Advocate Foundation, Shelley Fuld Nasso of the National Coalition for Cancer Survivorship and Sara Van Geertruyden of the Partnership to Improve Patient Care. Join us on December 2 and ask your questions about building patient-centered payment models.” Click here to register for the webinar.
5. In Comments to CMS, AAHD/Lakeshore Foundation Endorses PIPC’s MACRA Comments
In recent comments to the on the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the American Association on Health and Disability and the Lakeshore Foundation endorse the comments recently submitted by PIPC. In PIPC’s comments, it’s noted that implementation of MACRA provides an opportunity to advance a health system that meets the principles of patient-centeredness and therefore empowers and activates patients in their own care. The full comments submitted by PIPC to the Centers for Medicare and Medicaid Services (CMS) are available here.
AAHD states, "We appreciate the goal of moving health systems toward alternative payment models and new delivery systems that move away from fee-for-service and place value and quality over volume. Both the MIPS and APM include advancements in paying for quality and value. We also appreciate the need for APMs to be innovative and not-yet-defined. However, advancements made in paying for improved health equity and accessibility under the MIPS should not be lost under APMs. We encourage CMS to include the measures of accessibility, health equity, and social and community involvement in APMs."
6. KHN: Researchers Say Their Path To Better Health Starts With Patients’ Input
As recently reported in Kaiser Health News, “The Patient-Centered Outcomes Research Institute (PCORI) already has funded 468 studies, and last month opened the second phase of a program to create research networks covering specific diseases and involving millions of patients across the country. The institute’s work, known as ‘comparative effectiveness research,’ poses deceptively simple questions to find out vital information about which therapy or medication works best in the real world. Institute research goes beyond clinical trials and so-called “best practices” and extracts evidence from the individual experiences of massive numbers of patients… The key feature of comparative effectiveness research, no matter how it is conducted, is to ‘improve patient care,’ the Mid-South’s Rothman said. ‘Clinical trials typically test the effects of drugs against a placebo, while comparative effectiveness research compares one standard treatment to another in a real world situation to see what works better. We’re taking the next step.’” Click here to view the article.