Today HCFA hosted the consumer stakeholder engagement meeting with the Special Commission on the Health Payment System. The Payment Commission is holding a second round of meetings with stakeholders prior to their coming up with recommendations for revamping the health payment system in Massachusetts.
Their first meeting to begin discussing recommendations will be this Friday, April 3, from 12-5 (5 hours!), at 1 Ashburton, 21st floor, Boston. Materials will be posted here.
At today’s consumer session, Commission consultant Michael Bailit heard from HCFA, consumers from the Consumer Quality Council, Mass Public Health Association, AARP, Mass Law Reform Institute and Community Catalyst.
We prepared a preliminary list of points for the Commission to consider. What do you think?
Health Care For All strongly supports reform of our health payment system. Our current system, built on a foundation of fragmented fee-for-service payments, does not promote high-value and high-quality care. We support an all-payer reform that rewards accessible, coordinated, patient-centered care that focuses on health and disease prevention. Payment methodologies should favor primary and preventive care, encourage collaboration among providers and include accountability for patient health. Payment systems must also take into account the role of public health, and the special health care requirements of those with particular needs, such as the disabled, those chronically ill, immigrants, low and moderate income people, seniors and children.
We ask that the Commission take into consideration the following points in formulating its recommendations:
1. Transparency. The payment system must be totally transparent. Measures of care and incentives built into payment system must be open, transparent, and understandable by patients, such that each patient can see how these incentives are related to him or herself. Consumers must have access to their own medical records. Transparency must take into account linguistic capacity and cultural awareness.
2. Phased-in approach to bundled/global payments. We believe that over time, payments should cover larger bundles of services in both time and number of providers. An immediate first step is to decrease payments for potentially preventable hospital complications and potentially preventable hospital readmissions.
Vulnerable consumers need to be protected. We must guard against any structure that would incentivize providers to avoid high risk or chronically ill patients. Any risk adjustment should include provisions for socio-economic status and other social factors affecting care. We need proven systems in place that achieve real care coordination.
3. Patient activation and empowerment. A number of patient activation and patient empowerment methods have been shown to lead to better health outcomes, reduced disparities, and better satisfaction with one’s health care, as well as reduced costs. Models such as chronic disease self-management, ideal medical practices, and others should be promoted by a payment system that supports medical homes and other patient-centered practice arrangements. Measurably and systematically increasing patient empowerment is key to improving quality and stabilizing health care costs
4. Value-based benefit designs that support prevention and primary care. We support benefit designs that reduce or eliminate cost sharing for cost-effective preventive services and primary care. We oppose tiering arrangements and high-deductible plans that place inappropriate burdens on consumers who are not equipped to understand or accept the risks these plans impose on patients.
5. Support the role of public health through the payment system. Public health concerns must be integrated with the payment system. Patient education by community health workers and others should be accounted for in payment models. Payers should contribute to cost-effective public health interventions that improve the health of the general population.
