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.
PIPC has asked CMS to pursue reform in defining clear, consistent processes for engaging patients and other stakeholders in the development and implementation of CMMI evaluations, as well as defining and adopting detailed criteria for patient-centeredness. A panel of patient advocate experts convened by PIPC stressed that by advancing demonstrations that embody patient-centered reform and encourage individualized care, CMS can demonstrate their commitment to changing the culture of health care. Doing so will require significant engagement with patients, but changing culture is not easy. The advocates specified that driving a culture of patient-centeredness in how we pay for health care will require CMMI to similarly mandate and enforce engagement of patients in developing, implementing, and evaluating alternative payment models.
Among the highlights of the panel discussion:
Keynote: An Update on Innovation and Quality Improvement Efforts at CMS
Ms. Amy Bassano, Acting Director of CMMI, highlighted the extensive work being done by the agency to engage stakeholders in the creation and delivery of innovation in care. She explained that the Innovation Center has turned out more than 30 models since its creating as part of the Affordable Care Act (ACA), but recently turned their attention to “dipping their toe into” innovation in patient experience and beneficiary focused efforts. The diabetes prevention program was one of the first models to meet statutory requirements for expansion, and she noted the agency was proud to have shown such success in a deterrence-focused model.
As the new administration looks to weed out ineffective programs, they have recommitted to enforcing a statute dictating that the agency must modify or eliminate care programs that don’t appear to be functioning as intended. Ms. Bassano clarified that the administration’s support for this law gives the agency flexibility in model design, as they have the ability to adjust models to patient and care trends in real-time. For this reason, patient experience monitoring has become more important than ever as the agency can use care and payment models to more effectively gauge the potential impact.
A recent RFI from the CMMI asked all stakeholders in the health care industry to weigh in on what they would like to see expanded on in future care and payment models, and how better to cater to the needs and wants of patients. Ms. Bassano reported that the agency is taking their time going through the comments, to fully consider the ideas and concerns voiced by stakeholders. She explained that CMMI is thoughtfully studying what directions to take future models, including but not limited to: (1) consumer-directed care models, (2) models that target physician specialties and chronic diseases, (3) prescription drug models, (4) Medicare Advantage innovation models, (5) state based and local innovations, (6) mental and behavioral health models, and (7) program integrity retention practices. It was emphasized that patients would be asked to become more involved in the design and development process, and she explored the idea of possibly requiring facilities or providers to engage with patients in order to guarantee feedback.
Panel Discussion: Patient Perspectives on Increased Engagement in Care Delivery Design
Although patients are just as diverse as the illnesses they face, they all agree on one thing: increasing patient voice is necessary in the future of care delivery. Patient advocate organizations can be an incredible resource to government agencies looking to include patient perspectives, and often serve as the translator between patient concerns and wants and government intricacies.
Eric Gascho of the National Health Council stressed that engagement is key to better care, and suggested that patient perspectives be more highly valued in treatment and drug development as well as evaluation while directly participating in care. He specified that it is just as important to make sure engagement activities are fit for the purpose, and that the purpose is transparent to patients. Many would go on to push greater use of patient advocate organizations, and he cautioned that CMMI should also know their limits in reaching underserved communities and work toward engagement opportunities to meet that need.
Suzanne Schrandt of the Arthritis Foundation agreed that patients need to be monitored in their place of care in order to maximize engagement, and explained that CMMI should make use of patient advocates as they often serve as the “translator” between the two parties. She emphasized that patient advocate organizations know best how to engage with patient voices in a way that is familiar and relatable.
The issue of innovation in care and an aging population is one that many patient advocates think should be more thoroughly explored, and Dr. Joanne Buzaglo of the Cancer Support Community proposed care models should focus on how patients addressing paying for care as they live longer than previous generations. She also suggested that CMMI leverage the feedback of advocacy organizations, as they often have a registry of advocates and caregivers from which to pull when patient experts are needed.
Collaboration within the administration was also stressed a major roadblock to quality care. For example, Tom Berger of the Veterans Health Council of Vietnam Veterans of America specified that differences in care between the DOD and VA could complicate access to treatment. He encouraged patients to make use of the CMMI RFI and serve as the “expert perspective” on issues in care the agency may not be aware of.
All four patient advocates explained they would be most interested in alternative payment models (APMs) that more closely align individual focus and care coordination, with emphasis on a care team and family-developed individual care plan. Transparency emerged a major issue for Mr. Gascho, who expressed concern that behind-the-scenes incentives for providers may influence making care decisions. The ability to opt out and a rigorous evaluation were also noted by Dr. Buzaglo as keys to a successful care model.
Likewise, a payment model completely focused on reducing costs and resources used could induce “nightmares” for patient advocates, they explained. Mr. Gascho suggested that some patients are simply more resource intensive than others, and simple activities like screening for symptoms can improve care and quality while reducing costs. It was also clarified by Ms. Schrandt that certain specialties, such as rheumatology, find it complicated to deliver a streamlined patient-focused care model due to intricacies and personalization in treatment.
Although an ideal patient-focused care model would deliver on intense individualized care, Dr. Berger clarified many physicians already complain that greater patient monitoring takes time away from care by increasing paperwork. He explained that although quality measures are well intentioned, many are poorly designed and do not benefit for the time spent reporting. Dr. Buzaglo advised CMMI to put as much stock in designing worthwhile quality measures as they do in model design, otherwise poor reporting will not allow the agency to accurately gauge the effectiveness of the program. Quality can be a subjective indicator, and patient advocates suggested measurements need to reflect differences in access to care and the needs of the community.
Patients cannot begin to receive individualized care without the right tools to do so. Innovations in care should reflect the needs of the patient, Dr. Berger stressed, such as including a place within health records to track employment, industry, or time served in the military. For example, information on time spent in the military could provide doctors with critical insight on possible exposure to harmful substances. The patient advocates also asked CMMI to look into technology allowing physicians access to individual insurance cost and coverage information in order to more appropriately prescribe treatment. Focusing on aspects of a patient’s life that makes them unique, whether that be their occupation or access to affordable drugs, could improve health outcomes in ways previously ignored.
Among the highlights of the panel discussion:
- Eric Gascho, Vice President, Policy and Government Affairs at the National Health Council stressed that engagement is key to better care, and suggested that patient perspectives be more highly valued in treatment and drug development as well as evaluation while directly participating in care. He specified that it is just as important to make sure engagement activities are fit for the purpose, and that that purpose is transparent to patients. Many would go on to push greater use of patient advocate organizations, and he cautioned that CMMI should also know their limits in reaching underserved communities and work toward engagement opportunities to meet that need.
- Joanne Buzaglo, PhD, Senior Vice President of Research & Training at the Cancer Support Community, emphasized that care models should focus on how patients are paying for care as they live longer than previous generations, due to innovations in treatment. She also suggested that CMMI make use of advocacy organizations, as they often have a registry of advocates and caregivers from which to pull when patient experts are needed.
- Suzanne Schrandt, Director of Patient Engagement at the Arthritis Foundation, agreed that patients need to be monitored in their place of care in order to maximize engagement, and explained that CMMI should make use of patient advocates as they often serve as the “translator” between the two parties. She emphasized that patient advocate organizations know best how to engage with patient voices in a way that is familiar and relatable.
- Tom Berger, Executive Director at the Veterans Health Council of Vietnam Veterans of America, specified that differences in care between the Department of Defense (DOD) and the Department of Veterans Affairs (VA) could complicate access to treatment. He encouraged patients to serve as the “expert perspective” on issues in care that agencies may not be aware of. He discussed being a panelist himself as an example of how providing insight can directly yield benefit, as he was able to direct funding for veterans with Hepatitis C after serving on a stakeholder panel and raising the issue as one important to veterans.
Keynote: An Update on Innovation and Quality Improvement Efforts at CMS
Ms. Amy Bassano, Acting Director of CMMI, highlighted the extensive work being done by the agency to engage stakeholders in the creation and delivery of innovation in care. She explained that the Innovation Center has turned out more than 30 models since its creating as part of the Affordable Care Act (ACA), but recently turned their attention to “dipping their toe into” innovation in patient experience and beneficiary focused efforts. The diabetes prevention program was one of the first models to meet statutory requirements for expansion, and she noted the agency was proud to have shown such success in a deterrence-focused model.
As the new administration looks to weed out ineffective programs, they have recommitted to enforcing a statute dictating that the agency must modify or eliminate care programs that don’t appear to be functioning as intended. Ms. Bassano clarified that the administration’s support for this law gives the agency flexibility in model design, as they have the ability to adjust models to patient and care trends in real-time. For this reason, patient experience monitoring has become more important than ever as the agency can use care and payment models to more effectively gauge the potential impact.
A recent RFI from the CMMI asked all stakeholders in the health care industry to weigh in on what they would like to see expanded on in future care and payment models, and how better to cater to the needs and wants of patients. Ms. Bassano reported that the agency is taking their time going through the comments, to fully consider the ideas and concerns voiced by stakeholders. She explained that CMMI is thoughtfully studying what directions to take future models, including but not limited to: (1) consumer-directed care models, (2) models that target physician specialties and chronic diseases, (3) prescription drug models, (4) Medicare Advantage innovation models, (5) state based and local innovations, (6) mental and behavioral health models, and (7) program integrity retention practices. It was emphasized that patients would be asked to become more involved in the design and development process, and she explored the idea of possibly requiring facilities or providers to engage with patients in order to guarantee feedback.
Panel Discussion: Patient Perspectives on Increased Engagement in Care Delivery Design
Although patients are just as diverse as the illnesses they face, they all agree on one thing: increasing patient voice is necessary in the future of care delivery. Patient advocate organizations can be an incredible resource to government agencies looking to include patient perspectives, and often serve as the translator between patient concerns and wants and government intricacies.
Eric Gascho of the National Health Council stressed that engagement is key to better care, and suggested that patient perspectives be more highly valued in treatment and drug development as well as evaluation while directly participating in care. He specified that it is just as important to make sure engagement activities are fit for the purpose, and that the purpose is transparent to patients. Many would go on to push greater use of patient advocate organizations, and he cautioned that CMMI should also know their limits in reaching underserved communities and work toward engagement opportunities to meet that need.
Suzanne Schrandt of the Arthritis Foundation agreed that patients need to be monitored in their place of care in order to maximize engagement, and explained that CMMI should make use of patient advocates as they often serve as the “translator” between the two parties. She emphasized that patient advocate organizations know best how to engage with patient voices in a way that is familiar and relatable.
The issue of innovation in care and an aging population is one that many patient advocates think should be more thoroughly explored, and Dr. Joanne Buzaglo of the Cancer Support Community proposed care models should focus on how patients addressing paying for care as they live longer than previous generations. She also suggested that CMMI leverage the feedback of advocacy organizations, as they often have a registry of advocates and caregivers from which to pull when patient experts are needed.
Collaboration within the administration was also stressed a major roadblock to quality care. For example, Tom Berger of the Veterans Health Council of Vietnam Veterans of America specified that differences in care between the DOD and VA could complicate access to treatment. He encouraged patients to make use of the CMMI RFI and serve as the “expert perspective” on issues in care the agency may not be aware of.
All four patient advocates explained they would be most interested in alternative payment models (APMs) that more closely align individual focus and care coordination, with emphasis on a care team and family-developed individual care plan. Transparency emerged a major issue for Mr. Gascho, who expressed concern that behind-the-scenes incentives for providers may influence making care decisions. The ability to opt out and a rigorous evaluation were also noted by Dr. Buzaglo as keys to a successful care model.
Likewise, a payment model completely focused on reducing costs and resources used could induce “nightmares” for patient advocates, they explained. Mr. Gascho suggested that some patients are simply more resource intensive than others, and simple activities like screening for symptoms can improve care and quality while reducing costs. It was also clarified by Ms. Schrandt that certain specialties, such as rheumatology, find it complicated to deliver a streamlined patient-focused care model due to intricacies and personalization in treatment.
Although an ideal patient-focused care model would deliver on intense individualized care, Dr. Berger clarified many physicians already complain that greater patient monitoring takes time away from care by increasing paperwork. He explained that although quality measures are well intentioned, many are poorly designed and do not benefit for the time spent reporting. Dr. Buzaglo advised CMMI to put as much stock in designing worthwhile quality measures as they do in model design, otherwise poor reporting will not allow the agency to accurately gauge the effectiveness of the program. Quality can be a subjective indicator, and patient advocates suggested measurements need to reflect differences in access to care and the needs of the community.
Patients cannot begin to receive individualized care without the right tools to do so. Innovations in care should reflect the needs of the patient, Dr. Berger stressed, such as including a place within health records to track employment, industry, or time served in the military. For example, information on time spent in the military could provide doctors with critical insight on possible exposure to harmful substances. The patient advocates also asked CMMI to look into technology allowing physicians access to individual insurance cost and coverage information in order to more appropriately prescribe treatment. Focusing on aspects of a patient’s life that makes them unique, whether that be their occupation or access to affordable drugs, could improve health outcomes in ways previously ignored.
