Value assessment in general, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending. Currently, the most common method for determining incremental cost-effectiveness of healthcare interventions is based on a calculation of quality-adjusted-life-years (QALYs). While the model has a basic appeal for making population-level decisions (by reducing patient populations to single, aggregate numeric values), it also poses several significant concerns from the vantage point of patient-centeredness and efforts to preserve access to needed care for individual patients and people with disabilities. Of particular concern to me are the implications of use of QALYs for discrimination against people with disabilities, and its conflicting goals from the goals of personalized medicine.
In a letter to the Health Care Payment and Learning Action Network’s (LAN), PIPC applauds revisions made in the second draft of their Alternative Payment Model (APM) framework, while also raising concerns about the process and timeline to provide input. In the letter PIPC supports the fact that the new draft does not rely on cost effectiveness reports as a pillar for defining patient-centeredness in APMs. Additionally, PIPC strongly supports revisions made to move beyond damaging cost-effectiveness thresholds, and appreciates LAN's recognition of the importance of considering the risk of unintended consequences in APM design.
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.
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.
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)—whose members include organizations representing patients, people with disabilities and other stakeholders—today released a public opinion poll regarding healthcare delivery and access in America. The survey, which builds on prior surveys conducted by PIPC in 2013 and 2015, shows that of nearly 2,000 registered voters polled by Morning Consult, 8 in 10 say that doctors and patients should be able to decide the best course of treatment without government interference and that Medicare reforms should move toward patient-centered health care by giving physicians and patients the support they need to choose the best care for them
PIPC is proud to be a member of the Health Care Payment and Learning Action Network’s (LAN) Consumer and Patient Affinity Group (CPAG). The CPAG members were provided a rare opportunity to develop consensus-based consumer and patient principles to inform the work of the LAN and its many subgroups. A draft of the principles agreed to by the Leadership Committee of the CPAG are now available for comment. A list of the Leadership Committee members is available here.
Today, the Partnership to Improve Patient Care (PIPC) submitted formal comments to the Bipartisan Chronic Care Working Group of the Senate Finance Committee on their recently proposed policy options document.The four-person task force consists of Sens. Orrin Hatch (R-UT), Ron Wyden (D-OR), Johnny Isakson (R-GA), and Mark Warner (D-VA), and seeks to improve the treatment and management of chronic illness. PIPC's comments represent the viewpoints of a broad range of stakeholders dedicated to patient-centeredness and helps promote meaningful patient engagement in the design of future policy options.
Today, 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 the comments, PIPC expresses our 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.