Leadership is Needed

A blueprint for accelerating adoption of value-based care

 

We must work together as private and public purchasers

To break down barriers for private sector innovation

Systemic barriers exist that prevent health care from acting like an effective market that delivers valuable, innovative products at affordable costs. The intentions and efforts of patients, purchasers and providers to operate under the market-based principles of free and informed choice will continue to be inhibited unless government action is taken.

To use our purchasing power to spur change

As the largest single purchaser of health care, much can be done through the leadership of the Health and Human Services Department, Centers for Medicare and Medicaid, the Federal Employee Health Benefits Program, Department of Defense Tricare program, the Veterans Administration and the Indian Health Service. Additionally, there are some regulatory changes that could be made that would help spur value-based care in the private sector.


Value-Based Care Requirements

As America’s largest private health care purchasers, we have committed to work together and with government leaders at all levels to advance the requirements for value-based care.

Transparent Information
To be informed consumers, individuals and employers must have information about cost, quality, and outcomes to determine which health plans, providers, and services deliver the best value for their needs. Health care providers also need information to benchmark performance across local markets and engage in quality improvement activities.

Meaningful Outcome Measures
Meaningful standardized measures of clinical outcomes (e.g., what percentage of patients died within 30 days after heart surgery?), patient-reported outcomes (e.g., did your pain decrease after treatment?), and patient experience (e.g., did your provider listen carefully to you and treat you with respect?) must be publicly available for all health care providers, patients, health plans and purchasers.

Meaningful Choices
Patients must be free to choose the providers and services that work best for them, based on commonly available performance measures that effectively compare provider to provider and procedure to procedure. This includes price information for high priority conditions and services such as surgery and chronic disease management.


Appropriate Financial Incentives
Providers must be rewarded for delivering the best outcomes, rather than a discrete set of services. Patients also must have financial incentives to use high value providers and services.

 

Freedom to Practice and be Rewarded Under Innovative Payment Models
Providers must be free to practice medicine in ways that serve the best interest of patients. This requires regulatory relief that allows innovative practice designs,  smart incentives that reward outcomes rather than procedures, and simplifying reporting requirements by standardizing performance measures across all payers.

 

Proactive Public and Private Participation
New Provider payment models must be accelerated and harmonized across public and private payers, lowering the administrative burden on health care providers and amplifying the impact of incentives.