MACRA Comment: Building a Culture of Health Includes Payment Change

Screen Shot 2016-07-05 at 7.12.47 PMThe Robert Wood Johnson Foundation (RWJF) is striving to build a Culture of Health in this country where everyone has an equal opportunity to live the healthiest life possible, no matter where they live, learn, work, and play.  To get there, we need to make sure that everyone is getting the high quality, affordable care they want and need whether this care is provided inside or outside the health care system.  Right now in the U.S., we spend a lot of money on health care, especially as compared to other countries, but we don’t have the outcomes to show for it.  Last year, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 that would change how Medicare pays physicians with the goal of getting higher value for our health care dollars.   And recently, the Centers for Medicare and Medicaid Services (CMS) proposed rules for how these payment and reporting requirements would be implemented.

On June 23, 2016, RWJF submitted comments on these proposed rules.  We believe that changing health care payment in this country to reward better, rather than more care, is critically important.  In our comments, we shared lessons and insights from RWJF grantees to encourage CMS to design incentives in ways that will truly transform our health care system to provide measurably better outcomes for all.  We focused our comments on three areas: fostering integrated care, ensuring patient goals and needs are at the center of all we do, and providing high value care for everyone.

Fostering Integrated Care

Health is more than health care, so improving outcomes for all requires an integrated health and health care system that is able to fully identify and address a person’s needs, whether they are physical, emotional,  or social, no matter whether services are best provided by health care or elsewhere.  This requires a change in incentives for care providers to connect across sectors, and also to consider a patient’s whole health.  It also requires increased capacity in the social services sector, and improved information sharing. 

In our comments, RWJF urged CMS to continue its focus on ways to move the health care system toward a more integrated approach to care that considers the whole person by diagnosing and addressing the individual’s long term medical and social issues. Since 2005, RWJF has invested in better approaches to care in order to improve the value of integrated care for people with complex medical and social needs, and who account for a disproportionate share of health care costs. Key partners in this work include the Camden Coalition of Health Care Providers and the Center for Health Care Strategies. We are also in the process of developing a body of work to better connect social services and health care systems, recognizing the challenges that need to be addressed, but also the great potential for care improvement and cost savings.

Ensuring Patient Goals and Needs are at the Center

Just as health is more than health care, patients are more than diagnoses, conditions and treatments.  They are people with goals, needs, and preferences. In our comments, we emphasized RWJF’s belief that we need to take steps to ensure that the health care system envisioned by the proposed rules is one that is truly patient and family-centered.  This will require physicians and other providers to focus increasingly on delivering care that meets patients’ goals and needs.

In February 2015, in partnership with AcademyHealth, RWJF released a call for proposals to better understand consumer perceptions of values in different health care settings, at various decision points and using different insurance benefit designs. This research will be completed in the next few years and we will look forward to sharing the findings publicly. RWJF is also working with American Institutes for Research and our co-funder, the Gordon and Betty Moore Foundation, to better understand and identify true patient-centered measures, because in order for people to engage in decisions and receive high value care, they need measures that are useful and relevant to them. We strongly encourage CMS to prioritize patient-reported outcome measures, clinical outcomes, appropriate use, and patient experience in order to ensure that the care that is delivered is responsive to what patients want and need.

Providing High Value Care for All

Finally, we must recognize that it is critically important that the system incentives high value care for all patients.  To do this, providers working in all settings, including the safety net, must have the actionable information they need to understand the implications of their decisions on cost, and outcomes for their entire patient populations.

To help address this issue, RWJF is investing in efforts to build disparities-reduction goals into new payment and delivery transformation models. We are hopeful that CMS will also consider ways to develop and utilize explicit equity accountability measures that are sensitive to capturing disparities as part of their different value-based purchasing programs.

To see the actual comments we submitted, including specific references to grantees and programs, click here

Tara S. Oakman is a senior program officer with the Robert Wood Johnson Foundation.