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.
Under its current process, CMMI lacks the mechanisms to ensure new payment models are consistently developed and tested in ways that are transparent, that actively engage various stakeholders and that support patient-centered care. CMMI has been inconsistent in engaging patients in model development and testing, and this has prompted concerns from the patient community about several recent CMMI model tests. These CMMI proposals; which require participation on large scale (therefore enhancing the risk to patients), fail to include patient safeguards, and would come between patients and their doctors to impose one-size-fits all medicine; are irreconcilable with a patient-centered approach to value-based care.
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. PIPC is now working to make sure the patient voice is heard in three key areas that are defining health care value: value-based payment, value assessment frameworks, and research on comparative value. With respect to value-based payment, patients must have a seat at the table as these models are developed and tested. A more consistent strategy for engaging patients would yield small, controlled model tests that effectively engage and protect patients and incorporate a patient-centered perspective on value.
As part of its “Patient Voices, Patient Value” Initiative, PIPC is offering a roadmap for consistent patient engagement in the CMMI model design and testing process. This roadmap draws on best practices employed by CMMI in the development of earlier model tests, as well as best practices for patient engagement that have demonstrated success at the Patient Centered Outcomes Research Institute (PCORI), Food and Drug Administration (FDA), and Office of the National Coordinator for Health Information Technology (ONC). Specifically, PIPC recommends:
Given the complexity of the patient population, and that patient perspectives differ on an individual level, it is important that CMMI increase patient involvement to best understand this stakeholder groups’ unique perspectives on their individual needs, preferences, and care choices to align new payment models with care that patients value. Increasing the level of patient participation throughout the model development process will improve the impact of value-based payment models by yielding tests that put patient safety, care needs, and preferences first.
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. PIPC is now working to make sure the patient voice is heard in three key areas that are defining health care value: value-based payment, value assessment frameworks, and research on comparative value. With respect to value-based payment, patients must have a seat at the table as these models are developed and tested. A more consistent strategy for engaging patients would yield small, controlled model tests that effectively engage and protect patients and incorporate a patient-centered perspective on value.
As part of its “Patient Voices, Patient Value” Initiative, PIPC is offering a roadmap for consistent patient engagement in the CMMI model design and testing process. This roadmap draws on best practices employed by CMMI in the development of earlier model tests, as well as best practices for patient engagement that have demonstrated success at the Patient Centered Outcomes Research Institute (PCORI), Food and Drug Administration (FDA), and Office of the National Coordinator for Health Information Technology (ONC). Specifically, PIPC recommends:
- Improve oversight of CMMI by creating a Patient Advisory Panel to ensure patient-centeredness in the agency’s work.
- Require CMMI to follow a consistent process to seek input from patients and caregivers both early in the development of new demonstrations and throughout the implementation and evaluation process.
- Improve the transparency of model test designs and evaluation results.
Given the complexity of the patient population, and that patient perspectives differ on an individual level, it is important that CMMI increase patient involvement to best understand this stakeholder groups’ unique perspectives on their individual needs, preferences, and care choices to align new payment models with care that patients value. Increasing the level of patient participation throughout the model development process will improve the impact of value-based payment models by yielding tests that put patient safety, care needs, and preferences first.
| PIPC CMMI White Paper - A Roadmap to Increased Patient Engagement at CMMI.pdf |