patient voices in value-based reimbursement

Will “value to the patient” one day be a part of billing? 

In the shift to value-based payments, are patients’ voices being heard? The Center for Medicare & Medicaid Innovation (CMMI), along with other payers, has been busy for some time now developing and testing new alternative payment models (APMs), all in an effort to better align payments with value. But in the midst of this change, some are wondering if the patient’s perspective is being given enough weight in the equation.

Tony Coelho, chairperson for the Partnership to Improve Patient Care (PIPC), wrote an article calling attention to the need to increase patients’ involvement in the creation of value-based care models. Coelho, a former U.S. Representative and the primary author of the Americans with Disabilities Act, recapped a recent roundtable convened by the PIPC, the Cancer Support Community and other organizations that work with cancer patients. Following their discussion, the group made several observations:

  • Patient engagement is critical in shaping policies that drive value-based care. “Patients must be involved in the development of new models of care at the outset, and their success should be measured by their impact on patients,” Coelho states.
  • Shared decision-making is also crucial. Coelho writes there is currently little incentive to use shared decision-making tools as part of APMs. He points out that the care planning process should not only capture patient preferences, but allow for changing treatment goals over time, and that APMs should accommodate this.
  • The group stated that quality measurement must also evolve. They recommend the development of “measures that assess patient-reported outcomes, quality of life, and patient engagement” in order for APMs to reflect value to the patient.
  • Transparency and accountability were important themes identified by the roundtable. “Most patients are not even aware of the transition to value-based payments and its major implications for patient care,” Coelho writes. “CMMI should adopt a more open and accountable process for developing and evaluating payment demonstrations, while directly inviting feedback from impacted patients about the potential or real impact on care delivery.”

“Our healthcare system will never know how to measure and reward quality if we don’t ask patients what they value,” Coelho writes. For the policymakers and experts designing future payment models, factoring in patients’ priorities may be a challenge, but it is one well worth taking on.