As the House and Senate get close to releasing their versions of comprehensive payment and delivery reform legislation, the Campaign For Better Care, with the help of students from the Harvard School of Public Health, will be doing a series of blog posts this week highlighting our 10 Principles for Better Care.

2. Protection of Vulnerable Consumers: Payment policies should take into account the higher costs incurred by patients who experience barriers to care due to socio-economic status, language and other social/cultural factors. Patients with high medical utilization should be protected by outlier payments. The unique role of safety-net and disproportionate-share institutions should be recognized by the payment system.

The shift from wasteful fee-for-service to global and bundled payment systems will encourage providers to deliver health care more efficiently and at lower cost. We worry that increased financial risk will encourage providers to shun the most difficult and expensive cases or stint on effective care.

Key Policies:

• Risk adjustment under global or bundled payments must include adjustments for social, cultural and economic factors. Appropriate risk adjustment should be incorporated into payment reform to account for patients with high medical utilization, based on social and economic factors. Costs of care vary substantially among patients with similar medical conditions but varying social and economic profiles. If these are not taken into account, providers will face increased risk from caring for vulnerable or disadvantaged patients. This will support safety-net organizations that are disproportionally burdened with caring for those who need it most.
• Strict monitoring and enforcement of rules which prevent health plans from discriminating against patients are also essential to prevent patients from being denied access. The danger of cherry-picking and limited care could grow under global payments and other provider risk arrangements. The statute must have strong provisions, including substantial penalties, to guard against this.

Better care means protecting vulnerable people.
-Akash A. Desai