The health care system is moving to models that seek to pay for value. In January 2015, the U.S. Department of Health and Human Services (HHS) accelerated the movement towards value-based payments by setting a goal to shift 50 percent of Medicare fee-for-service payments to alternative payment models (APMs) by 2018.1 The Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS) is playing a significant role in advancing value-based or alternative payment models. In addition, many State health agencies and private payers are exploring similar changes. However, CMMI and other payers lack sound procedures and standards for patient-centeredness. Patient-centered approaches to value-based payment are needed to ensure that new payment models support value that matters to patients. To get it right, patient engagement is essential.
Value frameworks and similar value assessment tools are playing an increasingly prominent role in health care as insurance companies, Medicare, state agencies, and other stakeholders all are working rapidly toward "value-based" payment models. But will they pay for care that patients value? The Partnership to Improve Patient Care (PIPC) was founded on principles of patient-centeredness that cannot be achieved without engaging patients and people with disabilities. For the transition to a value-based health system to achieve outcomes that matter to patients, patients must have a seat at the table in defining value through the development of the value frameworks and tools.
Today, the Partnership to Improve Patient Care (PIPC) commented on the review of the proposed changes to the National Health Interview Survey (NHIS). "PIPC supports the recommendations of the CCD Health Task Force urging the National Center for Health Statistics (NCHS) to include age of onset questions to help identify the adult population with developmental disabilities, especially considering the NCHS decision to stop asking the questions about specific conditions," PIPC writes. "We urge the NCHS to develop and test questions to identify adults with developmental disabilities. Otherwise, we urge you to reconsider asking about the specific conditions (intellectual disability, autism, cerebral palsy, epilepsy and others) and the age of onset so that the data continues to identify individuals with developmental disabilities."
Today, the Patient-Centered Outcomes Research Institute (PCORI) held their Board of Governors meeting. The agenda can be found here.
Today, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho sent a letter to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt providing input on how to achieve patient-centeredness in alternative payment models (APMs) based on feedback PIPC received related to proposed models, including the Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR).
In the letter, Chairman Coelho provides a number of suggestions for bringing the voices of patients, people with disabilities, and their families to the discussion of how to advance patient-centered principles throughout an evolving healthcare system.
Today, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho sent a letter to the Department of Health and Human Services (HHS) expressing concerns with a proposed extension of Oregon's Medicaid Health Plan Extension. Currently, Oregon has a unique waiver from “EPSDT” – a foundational principle of Medicaid that makes health care for children a national priority, and specifically requires coverage of “all medically necessary diagnostic and treatment services." The system underlying the Oregon Health Plan is a prioritized list of services, that uses quality-adjusted life-years (QALYs) to help rank treatments in order of importance. High ranked treatments are funded; low ranked treatments are automatically denied regardless of medical necessity.
The Partnership to Improve Patient Care (PIPC) and over 40 organizations representing patients, people with disabilities and providers submitted a letter to the Institute for Clinical and Economic Review (ICER) in response to their request for input on their value assessment process. In the letter, the organizations stated, “Simply put, if we aren’t paying for care that patients’ value, we aren’t really paying for value-based care.”
The Partnership to Improve Patient Care (PIPC) has compiled a list of patient-centered resources that policymakers can and should be using to inform their development of public policy. Groups representing patients and people with disabilities know the populations they serve better than anyone, and that patients and people with disabilities bring credible and insightful data to the table. This list of the resources should be utilized by policymakers to inform the development and implementation of new payment models, quality measures and shared decision-making tools. Moreover, this work should facilitate facilitate more direct engagement of patients and people with disabilities in policymaking.
This list of resources will continue to be updated as information is compiled. Click here to fill out the survey.
Today, the Partnership to Improve Patient Care (PIPC) submitted comments on the implementation of the Merit-based Incentive Payment System (MIPS), Promotion of Alternative Payment Models, and Incentive Payments for Participation in Eligible Alternative Payment Models passed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Since its founding, PIPC has been at the forefront of patient-centeredness in comparative effectiveness research (CER) – both its generation at the Patient-Centered Outcomes Research Institute (PCORI), and its translation into patient care. Having driven the concept of patient-centeredness in the conduct of research, PIPC looks forward to bringing the patient voice to the discussion of how to advance patient-centered principles throughout an evolving health care system
The Partnership to Improve Patient Care (PIPC) held a roundtable discussion on May 6, 2016 to discuss the challenges of value frameworks in determining patient access. For the past several years, there has been a shift to a health care system based on value, rather than volume. Amidst this shift, “value to whom” has been a consistent question, with payers, providers, patients and other stakeholders defining “value” from different vantage points. PIPC has continuously advocated that value should first and foremost be considered through the lens of patients and people with disabilities who are the ultimate beneficiaries of health care.