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:
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:
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.”
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.