session audience photo

At the AcademyHealth National Health Policy Conference in February, several sessions addressed transforming payment and delivery to control costs, increase value and improve care. No longer a new theme, many experts tout alternative payment models (APMs), and new benefit designs as solutions to reign in cost-increasing incentives found in fee-for-service payment.  At the conference, we learned how models being tested under the aegis of CMS’s innovation center are playing out in health plans, integrated provider organizations and large employer initiatives. Another session emphasized that making these models work requires engaging consumers and patients in new ways in order to ensure that the reforms result in improved high value care. The insights from these thought leaders help us think about actions needed to involve people in every step of the transformation journey. 

To accelerate the adoption of next generation APMs, especially those with downside risk, as well as benefit designs that truly follow the principle of putting the patient at the center of the healthcare system, we need to take some new steps. It is hard if not impossible to find a public or private policy or delivery leader who does not espouse the importance of taking steps to gather comments and include consumers representatives on advisory bodies, including the programs offered by CMS’s innovation center. So what can we do differently going forward? Here are some ideas to get discussion started:

  1. Design alternate payment models in partnership with patients.  As Charlotte Yeh of AARP said of the care process, “it’s really about life, not only about health”.  A doctors’ visit can take two or more hours in the “consumer work flow of life”.  In designing APMs, patients and their caregivers should be engaged upfront and often throughout the process. APMs and the organizations that adopt them that are incented to innovate to make the patient experience better will have a better chance at success.  Is there care available after hours without using urgent or emergency care? Does the model incentivize addressing social and environmental determinants of health such as transportation availability?  Is care available over the phone or by email when appropriate?  And when does face-to-face better improve health? 

  2. Publicly endorse and apply person-centric principles developed by the Consumer and Patient Affinity Group of the Health Care Payment Learning and Action Network (LAN).  Released in 2016 these principles were intended to guide the development of new payment strategies. They were intended to provide “aspirational direction” and speak to all the ways consumers, patients, their families and advocates should collaborate in model design, application and evaluation. Today, three years later, leading innovators in payment and delivery reform could state publicly how they are following aspects of these principles. Clearly some innovators are doing so.  As Patrick Conway, now of Blue Cross Blue Shield of North Carolina and formerly of CMS stated, we need to “co-create the system with consumers”. That’s only one of the opportunities to illustrate how the principles are coming into use. 

  3. Recognize explicitly that people’s preferences and circumstances differ. Without bringing consumers and patients to the table early in the design, the opportunity to achieve health is lost. Reed Tuckson, who has worn so many leadership hats crossing all aspects of the healthcare system, stressed the importance of putting the patient into benefit designs that encourage them to be actively invested in their care. Mark McClellan of Duke emphasized that benefit designs need to be patient-centered to align with payment reform incentives. For example, what role do such elements as prior authorization and copayment have? 

The time is ripe to be creative in ensuring that payment reform and benefit design reap what only consumers and patients can provide. 

The authors would like to acknowledge that Mark McClellan is a MITRE Senior Visiting Fellow and that Reed Tuckson is a member of MITRE’s Health Advisory Committee.

The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth.

Organizational Affiliates are a critical link in AcademyHealth’s ability to effectively advocate for the field, and support the future field of health services researchers. Organizational Affiliates gain visibility among AcademyHealth membership, enjoy unique networking opportunities, and benefit from event discounts. Click here to learn more.

Anne Gauthier
Committee Member

Anne K. Gauthier, M.S.

Senior Health Strategist and Integrator - MITRE

Anne K. Gauthier is a senior staff member in the Center for Transforming Health at MITRE. Read Bio

Karen Adams headshot

Karen Adams

Portfolio Manager - MITRE

Karen Adams is a subject matter expert in the areas of health policy, clinical quality improvement, and perfor... Read Bio

Blog comments are restricted to AcademyHealth members only. To add comments, please sign-in.