When you think about fragmented, especially when you’re not under one roof… you talk to one doctor, they talk about one thing, you go to a different doctor, totally different symptoms, they’re prescribing medicine that don’t even work together and one medicine makes you sick because you took the other. So that is what is fragmented and complicated, nobody talking to each other, nobody getting their records, you’re responsible for carrying your records around. It’s not a good look. ~ Focus group participant 

Lack of coordination. Cost. Fragmentation. “Sick care” over “health care”. Exhaustion. Frustration. We consistently hear from patients that they are losing faith in our health care system, and it’s easy to understand why. They are fed up with paying more with no expectation of improved health outcomes and being treated as a series of symptoms rather than people. A growing body of evidence supports what people across demographic identities and political ideologies have told us through our extensive listening work. They want a system that delivers patient-first care (what some refer to as “value-based care”), which prioritizes quality over quantity and puts their needs first. 

Based on feedback from diverse patients, policy experts, and stakeholders, we’ve developed principles to guide policy reforms that deliver patient-first care. We know from demonstrations in states from Arkansas to Oregon that adopting patient-first care models improves health outcomes while reducing health costs. As people increasingly struggle with the cost of care and worry that our system is headed in the wrong direction, policymakers must take urgent action to deliver the health reforms they demand

Policy Principles to Achieve Patient-First Care

A patient-first health care system is achievable. To create the changes people say they want and need, United States of Care developed key policy principles with the generous input and expertise from a variety of stakeholders, including health providers, state and national health advocates, regulators, and other health policy leaders. These principles are a first-of-its-kind framework to help assess and evaluate whether policy reforms addressing payment and care delivery are truly centering everyday people. The following list not only walks through each principle, but shows how they can be put into practice.

Principle 2: Realign financial incentives to improve health outcomes

People want a system that rewards health providers for actually improving their health. Rather than paying for care based on the number of visits, tests, and procedures, a patient-first care approach allows people to spend more time with their providers so they address their full set of unique concerns in fewer visits.

I’m thinking that if you get into the performance part of it …somebody come in and they got issues instead of prescribing them medicine they’ll say hey ‘Can you go to a gym? Can you take this? Let’s look at your diet… maybe you eat too much of this, try this, try that’. Instead of being so quick to give out pills… That is what I really think it’s about, really take the time to know you versus insurance, ‘if I do this extra procedure, I’ll get paid for it.’ ~ Focus group participant 

Bright Spots

Payment models that reward quality over quantity have improved health outcomes while reducing costs. An example where financial incentives resulted in success is Vermont’s All Payor ACO Model which delivered notable savings (net reduction in state spending by 9.7%) in its first evaluation period, while reducing acute care stays and increasing access to primary care for Medicare beneficiaries. Our hope is to continue seeing these kinds of results as policymakers consider new policies and incentive structures to accelerate the movement toward patient-first care that can help even more peoples.

Principle 3: Deliver whole-person care

Everyone deserves to be treated as a whole person rather than a series of symptoms. Patient-first care means people have access to affordable health care that has demonstrated impacts on health outcomes, especially primary care, and providers coordinate to comprehensively address their needs. It also means that every patient receives high-quality care regardless of their race, income, or where they live.

I didn’t have much trust in my original doctor because I felt invisible. I was looked at as a number. It was really sad, people were scared at the time, things seemed like they were always moving so fast. I felt like I was rushed at my appointments. Honestly, this was my first birth in a different state. My previous healthcare providers were back in New York. I changed providers and it was awesome. My doctor was and is excellent. I love him. I have an appointment with him this coming week! He’s professional, thorough, kind, explains everything, and had me totally at ease. Just an awesome man!
~ Focus group participant 

Bright Spots

Primary care often serves as the foundation of a patient’s relationship with the health care system. When people have access to a usual source of care, they are more likely to receive high-quality health services. Similarly, when states orient resources to prioritize primary care, people have better health outcomes. More action is needed to invest in and reward the comprehensive, equitable care that improves people’s health, and CMMI has made some progress in recent models announced that expressly address whole patient care. In fact, the Transforming Maternal Health model makes “whole person care delivery” a central pillar of the demonstration, acknowledging how the pregnancy and birthing experiences are intimate and allowing for the provider-patient experience to address physical, social, and mental health needs not traditionally afforded in the maternal health journey.

Principle 4: Promote Accountability to Patients

Patient-first care models should adopt a core set of patient-reported quality measures across payers and populations to fully capture the patient’s perspective. The data collected from these metrics should be used to determine whether providers are achieving patient quality and health equity goals.

The system must get away from money and instill one that focuses on outcomes. There is no accountability. Doctors can get away with whatever they want, as long as they think it benefits the patient. It’s very risky. ~ Focus group participant 

Bright Spots

CMMI’s strategic objective to “Partner to Achieve System Transformation” includes a stipulation that all new models “collect and integrate patient perspectives across the life cycle.” CMS has begun testing and incorporating patient-reported measures of outcomes and experience in their models, with implementation of this strategy ongoing. For example, CMMI encourages beneficiary experience and patient-reported outcomes measurement in recent voluntary models such as within the AHEAD model, as well as within mandatory models such as the Comprehensive Care for Joint Replacement model, offering some flexibility for providers to become familiar with reporting on more comprehensive patient experience measures. 

People Demand Better

Diverse patients across demographics, political affiliation, geography, and more, as well as health care experts agree that our health system should focus on improving people’s experiences and outcomes rather than offering more units of fragmented, expensive, and poor quality care. In its recent strategy refresh, the CMS Innovation Center stated its goal to ensure that the majority of Medicare and Medicaid beneficiaries will be in a patient-first care relationship by 2030. This is a commendable goal, but ensuring it becomes reality will require continued dedication at all levels of government. We urge policymakers to use our patient-first care policy principles to deliver the care people demand.