Cross posted from Health Affairs.
The movement to transform the country’s health care delivery system has been underway for several years now, and some moments of truth are approaching. The ultimate success of this monumental effort to improve the way we pay for and deliver care will be measured not only by cost savings, but also by how well payment reform results in better health outcomes and a value-based system that delivers genuinely person-centered care.
The Health Care Transformation Task Force—a unique private-sector, multi-stakeholder group whose 42 members represent six of the nation’s top 15 health systems, four of the top 25 health insurers, and leading national organizations representing employers and patients and their families—has been at the forefront of helping to accelerate the pace of this transformation. As part of our efforts to transition our health care system toward value-based payment, we strongly support ensuring that new models of payment promote a person-centered care system that improves the care experience for patients and family caregivers. We believe that, to do this, patients and consumers must be engaged as partners at all levels of care and care design including the building of alternative payment models.
Genuine partnership is essential to the success of health care payment reform overall and to the ability of individual health care entities to make sustainable progress in their journey from fee-for-service to value-based payment. Patients and consumers have unique experiences and perspectives that are essential to consider as we build a system that meets diverse patient needs and enables them to engage effectively in care and health. Ultimately, consumer engagement will be essential to improving outcomes and care, reducing costs, and increasing health equity.
To support health care organizations engaged in transforming how they develop and deliver value-driven care that is person-centered, the Task Force brought together its diverse members to create a new consensus framework: Addressing Consumer Priorities in Value-Driven Care: Guiding Principles and Key Questions. Our new framework is premised on the simple idea that, to realize the goals of payment reform and delivery system transformation, a person-centered (often referred to as patient- and family-centered) focus and authentic partnership with consumers and patients must guide all aspects of delivery reform:
- model design;
- implementation, operation and evaluation of care;
- and genuine partnership between patients and clinicians at the point of care.
While this concept is straightforward, it is often at odds with deeply entrenched attitudes and today’s dominant paradigm about the role of patients in health care.
Fostering Person-Centered Transformation
Operationalizing authentic partnership can be a significant challenge requiring action and buy-in from many different stakeholders in health care. Gaining input from these stakeholders on how this can be achieved can be a challenge in its own right. The Task Force leveraged its unique, broad-based membership to develop this consensus framework to advance understanding of authentic partnership and what it means to be a person-centered care delivery organization.
Despite often good intentions, there is still great confusion about what it means for a system to be person-centered and, of course, there is no “one-size-fits-all” formula for getting there. We developed this action-oriented framework to help health care organizations assess current practices and develop new thinking and strategies about how to partner with patients and consumers and, in turn, deliver care that is truly person-centered. Task Force members are committed to using this framework as a starting point for their own efforts, and we urge others to follow suit.
The framework provides a set of building blocks organizations can use depending on where they are in the journey toward authentic partnership and person-centered care. Building blocks range from articulating a vision to identifying practices and tools to implement and evaluate progress.
Establishing Guideposts For Achieving Person-Centered Health Care
The framework blends the perspectives of four key stakeholder groups that together represent the care delivery spectrum:
- people (consumers, patients and their caregivers),
- purchasers (private and public),
- providers (across the spectrum of care),
- and payers (plans and insurers).
We reached consensus on the following definition:
A person-centered, value-driven health system provides safe, effective, personalized, affordable, and high-quality health care services that meet the needs of individual consumers as well as those who support their care, including family, friends, patient-authorized caregivers, and community service providers.
This definition provides overarching direction for organizations that are striving to deliver person-centered care.
In addition, the Task Force considered how best to engage patients/consumers in taking shared responsibility for their health and care. We converged on the idea that a person-centric, value-driven health system provides both patients and their caregivers meaningful and effective ways to share in decision-making and care-planning at each point in the process.
The Task Force used these consensus definitions of person-centered care and shared responsibility to develop guiding principles coupled with granular questions designed to help health care organizations consider important opportunities and benchmarks for fostering partnership and achieving a value-based care model that is person-centered.
Guiding Principles And Operational Questions
This principles-based framework is action-oriented and designed to be a hands-on tool that facilitates change. It provides six guiding principles accompanied by operational questions to aid a health care organization in becoming more person-centered. Organizational leaders can use these questions to identify concrete ways to foster partnership, set benchmarks, and evaluate progress toward integration of the principles into their organization’s culture and transformation to value-based, person-centered care.
The principles and accompanying questions are available online and outlined below.
1. Include Patients/Consumers As Partners In Decision-Making At All Levels Of Care
- Are patients/consumers included as integral partners in all aspects of health care decision-making at every level, from system-level reform and design to point-of-care decisions?
- Are patients/consumers meaningfully engaged in governance and oversight?
- Are consumers meaningfully included in program design and implementation?
- Are person-centered performance measures included?
- Is leadership committed to supporting and cultivating changes in culture required to foster true partnerships with patients at all levels of care?
- Does the system’s design strengthen consumer engagement in design-making relating to their own health and wellness?
- Are appropriate mechanisms for helping consumers take responsibility for their care considered?
2. Deliver Person-Centered Care
- Are patients/consumers and those who support them at the center of the care team?
- Is a clear and accessible point of contact available to support patients in health-related decision-making no matter where they go for care?
- Are evidence-based clinical care models used that support effective care coordination across the patient’s care network?
- Are patient-centered workflows supported?
- Are appropriate consumer disclosure and transparency mechanisms supported?
- Is the capacity to provide care to consumers in a safe, effective, coordinated, and comprehensive manner being put at risk?
- Are patients protected from “narrow network” limitations?
3. Design Alternative Payment Models (APMs) That Benefit Consumers
- Do APMs achieve cost-saving only through improvements in health and health care and do they ensure beneficiary rights and protections?
- Do consumers benefit?
- Are consumers’ rights safeguarded and disclosed?
- Are vulnerable populations protected?
- Do high-priority populations benefit greatly?
- Do consumers have choice?
- Is transparent quality performance data accessible to consumers for evaluation?
4. Drive Continuous Quality Improvement
- Do the health care transformation policies and practices generate meaningful feedback and information; do they drive continuous quality improvement?
- Are patients and their authorized caregivers meaningfully engaged in quality improvement efforts?
- Have all the types of data needed to evaluate efficacy for consumers been considered?
- Are quality improvement structures and processes supported?
- Are quality improvement requirements supported?
- Are up-to-date quality measures being used?
5. Accelerate Use Of Person-Centered Health Information Technology
- Do alternative payment and care delivery models accelerate the effective use of person-centered health information technology (Health IT)? Do they enable people to better participate in their care and manage their health?
- Is use of person-centered Health IT supported?
- Does the effort incorporate strong consumer health data access, privacy, and security provisions?
- Does the effort encourage interoperable health information exchange with all parties in the care network?
- Are all parties in the care network able to gather and share appropriate electronic health data for this effort with consumers and one another?
- Have all relevant types of data needed for this effort been considered?
- Are consumers able to use patient portals, apps, and telemedicine systems to exchange information and communicate about the program?
6. Promote Health Equity For All
- Does the health care delivery system and payment reform model promote health equity and seek to reduce disparities in access to care and in health outcomes for all?
- Does the effort support links to community-based services and supports and to other programs that address the social determinants of health, such as housing or food and nutrition programs?
- Does the effort support the use of a diverse health care workforce, including the use of community health workers?
- Does the effort support special health care services for at-risk populations?
- Does the effort support access to data needed to assess health equity-related impacts?
- Does the effort support formal structures for identifying and addressing disparities?
- Does the model’s payment policy support risk adjustments, where appropriate, based on socioeconomic status and demographic factors, while at the same time ensuring that non-risk-adjusted data is publicly available?
Task Force members encourage industry leaders to consider all six principles as they develop and implement value-based care. The accompanying questions offer potential inquiries for organizations to consider as they design, implement, and assess value-based payment and care delivery models.
We hope and expect that the Task Force’s consensus framework will make a significant contribution toward advancing a person-centered, value-based care system, but we also recognize that it is only a start.
We encourage dialogue at health systems across the country and look forward to feedback as this framework is used. The Task Force members are committed to ongoing learning, to refining this consensus framework, and to offering additional guidance in the months and years ahead as we collectively work to shape a health care system that is value-based and person-centered and that delivers on the Triple Aim.
Authors’ Note: The authors are members of the Task Force’s Executive Committee and represent organizations from each of the four key membership constituencies. The authors recognize and appreciate the work of the Task Force’s Advisory Group for Consumer Priorities in developing this consensus framework.