Payment Reform Commission Meets Friday; And Our Principles

The Payment Reform Commission will meet Friday, May 8th, from 11:00 am – 2:00 pm in the 21st floor conference room of One Ashburton Place, Boston. Materials for the meeting will be posted here. We’ll try to post a full report after the meeting.

We expect the Commission to continue discussing how to move the Massachusetts health care system towards global payments. The Commission must decide several key issues including how global payment amounts will be determined, how to motivate providers to move to global payments and how fast movement can occur.

Today’s Globe covered the basics on the Payment Reform Commission’s progress (fast), and Paul Levy added comments on his blog, as did Charlie Baker, and Celia Wcislo, on WBUR’s CommonHealth blog.

Consumer groups met with the Commission staff last week, and HCFA presented an updated version of our principles around payment reform:

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 simplify the medical care process for consumers, promote 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 principles 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, so that people can understand how the incentives relate to their care. Consumers must have access to their own medical records.

2. Simplicity. The current payment structure exacerbates the already-complex health care system. The payment system should promote simplicity and ease of navigation. For example, patient bills must be understandable. Linguistic capacity and cultural awareness should also be taken into account in the payment structure.

3. 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. A first step, which would provide real, immediate savings, is to decrease payments for potentially preventable hospital complications and potentially preventable hospital readmissions. Ultimately, fair global payment systems should be considered only as supported by data and experience.

4. Vulnerable consumers need to be protected. We must guard against any structure that would incentivize providers to avoid high risk or chronically ill patients. Risk should not be entirely shifted to providers. 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.

5. 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 practice, 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.

6. 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.

7. 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.

While the Commission process is moving quickly, there is still significant distance to go before what are likely to be general recommendations gets translated into specific proposals. We look forward to a continued robust discussion that puts those with the most to lose, health care consumers, at the center of the policy process.
Catherine Hammons and Brian Rosman