Today’s events at the White House and U.S. Department of Health and Human Services (HHS) highlighted the growing interest from policy makers and stakeholders in shifting the health care payment system to support greater quality of care rather than the quantity of care provided to patients. PhRMA has long supported policies to advance affordable, high-quality, individualized care, and we were pleased to participate in today’s inaugural meeting of the Learning and Action Network (LAN), an initiative of HHS to discuss payment and delivery reform.
The new payment models promoted under this initiative are under the early stages of development and testing and, as noted by many stakeholders and health care experts, hold significant implications for patient access, care quality, medical progress, and the physician-patient relationship. The Oncology Care Model (OCM) recently released by the Center for Medicare and Medicaid Innovation illustrates the opportunities and challenges in alternative payment models. While the OCM promotes care coordination and patient engagement, it also could have unintended consequences like restricting patients’ ability to change providers, undermining care quality, and restricting patient access to treatment options.
Five ‘building blocks’ could help ensure that the HHS’ initiative achieves better outcomes for all patients, including:
- incorporating clear mechanisms for recognizing new treatment advances, including personalized medicines;
- expanding the foundation of quality and patient-reported outcomes measures in alternative payment models;
- promoting informed patient decision-making from the range of available tests and treatment options;
- taking a holistic, system-wide view of cost and quality; and
- creating mechanisms for broader stakeholder input in development and evaluation of new payment models.
Consistent with President Obama’s Precision Medicine Initiative, we believe the primary goal of payment reforms should be to increase the benefit that individual patients receive from their health care and to ensure the patient is not forgotten when assessing the impact of payment reforms. Through the LAN, we hope that stakeholders will be actively involved in discussions about the challenges and opportunities presented by growing interest in alternative payment models to ensure these reforms meet the standard of improving the quality of care for individual patients and not just the average.
HHS’ initiative holds great promise and today’s events were a positive first step in working toward better care, smarter spending, and healthier people. PhRMA looks forward to being actively engaged in the initiative and ensuring that the individual patient is at the crux of emerging reforms.