Partnership, Equity, and Transparency: Key Themes for Primary Care Payment

This week, Medicare Rights joined health care leaders from across the country for the annual summit of the Health Care Payment Learning & Action Network (LAN). As a committed partner of the LAN, Medicare Rights is one of over 130 national and state organizations working to change how health care is paid for—moving away from paying on the basis of volume (meaning paying a fee for each discrete service) to paying for value (meaning paying for better quality care at a lower cost). Medicare Rights was proud to be an invited member of the LAN’s Primary Care Payment Model (PCPM) Work Group. As part of the Work Group, we added the consumer and patient perspective to a draft white paper on optimal ways to pay for and deliver primary care services.

At the summit, we participated in two listening sessions on the draft white paper. Medicare Rights spoke to three themes critically important to patients and their families that must be considered as Medicare and other payers explore new ways to reimburse for and provide primary care. Those themes include:

• Partnership: The PCPM Work Group all agreed that primary care is best delivered by teams—not by one doctor alone. It is essential that patients themselves are clearly regarded as an equal member of that team. This means that patients should be active partners in developing their care plans and identifying goals. Similarly, patients and their families should be partners in developing new ways to pay for and deliver primary care. This means soliciting patient input at the policy level (like when Medicare designs a new care model) and at the governance level (like when a practice rethinks its policies and procedures). 

• Equity: Changing primary care payment mechanisms may have unintended consequences, such as creating disincentives to provide care to higher cost patients with more complex needs. The PCPM Work Group agreed that safeguards are needed to prevent any such consequences.As such, the draft white paper notes the need to appropriately risk-adjust payment and to ensure the right quality measures adopted in new payment models. Tools like these are especially important given evidence which clearly shows that disparities in accessing needed care exist in our current health care system, particularly among low-income populations and communities of color. 

• Transparency: As Medicare and other health systems change how they pay for care, it is important that patients and their families have access to information, both about their own health and about the new payment incentives their care teams are operating under. The PCPM Workgroup notes this need for transparency throughout the draft white paper.Importantly, the white paper also acknowledges that information for patients must be truly accessible—meaning that it is readable to people with differing literacy levels, available in a range of accessible formats, written in peoples’ primary languages, and more. Consulting consumers, patients, and their advocates when developing materials is one way to ensure these important goals are met.

We are proud to see these three themes reflected in the principles and recommendations of the LAN’s draft white paper on primary care payment models. The draft white paper is now open for comments from the public. Medicare Rights, the PCPM Work Group, and the LAN welcome thoughts on how to strengthen the white paper, including on the themes of partnership, equity, and transparency.

Read and comment on the draft white paper.