An Opportunity to Advance Patient- and Family-Centered Care

by | Jul 8, 2016 | Choosing Health Equity

The Medicare Access and CHIP Reauthorization Act (MACRA) will bring the biggest change in decades to how we pay physicians, nurse practitioners and other health care providers who treat Medicare beneficiaries. Making sure we get MACRA implementation right is important, not only for the more than 55 million Americans who are Medicare beneficiaries, but for all of us. How Medicare pays for care drives change throughout our entire health care system. Said another way, how Medicare pays doctors and other health care professionals affects the care we all receive.

MACRA is moving health care payment and delivery in a positive direction – but it is critical that even more be done to make sure implementation of the law results in improved care for patients and families.

With MACRA, policymakers are aiming to shift how we pay for health care away from fee for service and toward value-based payment. That means moving toward a system where providers will be rewarded based on the quality and efficiency of the care they provide, not just on the quantity of services they provide.

The National Partnership is leading efforts to ensure MACRA is implemented in a manner that reflects the priorities of consumers, patients and families. Last week, we submitted comments to the Centers for Medicare & Medicaid Services (CMS) with recommendations for strengthening the proposed MACRA rule. Here are a few highlights:

Reinforce that New Payment Models Must Facilitate Patient- and Family-Centered Care
If we are serious about achieving the Triple Aim – better health outcomes, better experience of care, and lower costs – CMS and participating providers must give as much attention to improving the delivery of care as they do to reducing spending.

One way CMS could support this goal is by requiring payment models that qualify as Advanced Alternative Payment Models (Advanced APMs), and therefore receive higher reimbursement rates, to show they promote and support more patient- and family-centered care. This could mean demonstrating that the model improves care coordination and continuity, increases responsiveness to patient and family caregiver needs, and fosters effective patient-clinician partnerships through shared care planning and decision-making and use of patient feedback and patient and family advisors.

Promote the Robust Use of Health Information Technology (Health IT)
Health IT can help patients and caregivers make better informed decisions; connect with their health care providers; generate and share important health information; and set, track and achieve personal health and wellness goals. This kind of engagement, access and partnership is essential to improving care coordination and health outcomes, so it is imperative that person-centered health IT is fully integrated into new models of health care payment.

To that end, we feel it is critical that CMS go beyond the “one patient” requirement in the Merit-Based Payment Incentive System’s Advancing Care Information performance category. The “one patient” threshold only requires providers to demonstrate that they have used functions like electronic prescribing, patient electronic access and secure messaging with one patient each year. This is insufficient to meet consumers’ health needs in today’s fast-paced, tech-savvy world. Instead, CMS should move quickly to increase the threshold to five percent of providers’ patients.

(In comments we submitted on behalf of the Consumer Partnership for eHealth, we offer additional recommendations for strengthening the role of health IT in MACRA. Read those comments here.)

Implement Safeguards that Will Protect Patients and Families Over Time
MACRA encourages health care providers to take on greater responsibility for managing the cost of delivering care to their patients. In return for this increased responsibility, clinicians are eligible to receive greater financial rewards for provision of high-quality, high-value care. This should foster more effective ways for providers to ensure that their patients get the right care, at the right time, and in the right setting. However, if clinicians are taking on increased responsibility for managing costs, it is important that CMS also ensure that consumers’ access, experience and quality of care are protected.

In addition, it is important that consumers understand what it means to be a part of an alternative payment model and how changes to health care reimbursement could impact their experience of care. These models should never intentionally or unintentionally inhibit access to needed care. Therefore, the new payment models should include a greater emphasis on consumer outreach and education. They should also have provisions that ensure consumers have adequate choice of providers, access to needed care, and an understanding of how new payment and care delivery models work. Additionally, these new payment models should routinely collect data that helps providers, CMS and consumers identify and address disparities in health, health outcomes, care experience, access and affordability.

Our comments on the proposed MACRA rule also address a number of other elements with important implications for patients and families; read the full comment letter here. The National Partnership also submitted comments on behalf of the Coalition for Better Care and the Consumer Partnership for eHealth. You can see these, and additional resources on MACRA, at