“Americans stand today at a historic crossroads: Before us lies the opportunity to fix a health care system that is beset by high costs, inefficiencies and inadequate coverage.  I applaud this committee for starting off with a focus on our system’s delivery of care. We will not achieve meaningful reform unless we improve our health care delivery system so that more people have access to better, more affordable care and get better value for their health care dollars.

As we advance reform, we must make patient-centered care our guiding light. A health care system that puts a greater emphasis on patients’ needs will help improve the quality of health care, lower costs and make health care more accessible, especially for the most vulnerable among us—those with multiple serious chronic conditions, and especially those whose medical conditions are complicated by physical or cognitive impairment or whose access to health care is limited by their low income, race or ethnicity.

These are the people who make heaviest use of the current system, at the highest cost, but with the poorest outcomes. Yet despite this spending, the system does not serve them well because it is oriented toward treating acute needs rather than managing chronic conditions; rewards quantity of services over quality of care; and promotes fragmentation over coordination. As a result, our most vulnerable patients do not get the care they want or need, do not get better, and often feel abandoned and overwhelmed by the system.  The ultimate measure of our success is whether we can create a delivery system that addresses the needs of these most vulnerable patients. If we can make the health care system work for them, we can make it work for everyone. If we fail them, we will never get health care spending under control.

Whatever model we choose to deliver health care, it must take patients’ wants and needs into account. By that, we mean that:

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  Care is comprehensive, coordinated, personalized and planned
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  Patients’ experience of care is routinely assessed and improved
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  Patients and their caregivers are full partners in their care
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  Transitions between settings of care are smooth, safe, effective and efficient
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  Patients can get care when and where they need it
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  Care is integrated with the community resources patients need to maintain health and wellbeing
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  Continuous quality improvement and elimination of disparities are a top priority

As we prepare to draft legislation to overhaul the nation’s health care system, we must take two key steps to ensure we satisfy these requirements of patient-centered care.

First, we must restructure payment systems so they reward coordinated, integrated and accountable care. To achieve this goal, we must increase payments to primary care physicians and eliminate the distortions in physician fee schedules that have produced an over-supply of procedure-based specialist services at the expense of chronic care management, coordination and support that patients desperately want and need. 

We must change the way the Centers for Medicare and Medicaid Services (CMS) makes decisions about payment.  Patients and consumers should have a voice in decisions that ultimately define how care gets delivered. 

We also must adequately reimburse primary care practices for care coordination and management services, and ensure that the level of payment matches the complexity of patient need.  We must support better management of care transitions across different settings and providers.  And we must link payment to the quality and outcomes of care.  These payment changes must compel physicians to redesign their practices so they place a greater focus on patient-centered outcomes.

Second, we must rebuild our health care infrastructure so we are better able to deliver the high quality, coordinated care patients need.  This will require:

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  A strong foundation of measurement, reporting and ongoing quality improvement.
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  Widespread adoption of health information technology (HIT) that helps us improve quality, coordination, and safety, engages patients and caregivers, reduces costs, and allows assessment of quality and improvement.
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  Comparative effectiveness research that gives clinicians and patients better information about what works and what doesn’t, and enables them to make good decisions about treatments and services.
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  The right tools and strategies to engage patients and caregivers in managing their health and making health care decisions.
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  An adequate workforce, appropriately trained, in sufficient numbers, and effectively deployed to meet the needs of our population particularly those who have been traditionally underserved, and the rapidly growing number of individuals with multiple chronic conditions and geriatric syndromes.

If we fail to take these steps toward patient-centeredness, we will ultimately fail the test before us: reforming our health care system so we improve quality, make care more affordable, and get better value for our health care dollars.”