Principles for Patient- and Family-Centered Payment

Physician comforting patient

These principles, produced by the Consumer and Patient Affinity Group, are intended to help guide the development of new payment strategies. They provide guidance and aspirational direction to ensure that we address the needs and priorities of patients and families as we transition to value-based payment. The principles rest on the conviction that consumers, patients, and families are essential partners in every aspect of transforming health care and improving health.

 

 

Consumers, patients, families and their advocates should be collaboratively engaged in all aspects of design, implementation, and evaluation of payment and care models, and they should be engaged as partners in their own care.

The collaboration in design of payment and care models should include oversight, governance, and interface with the communities where care is delivered. At the point of care, patients and families should be engaged in ways that match their needs, capacities and preferences. Collaborative care should be aligned with patient goals, values and preferences (including language), and should reflect shared care planning and decision making throughout the care continuum.

Positive impact on patient care and health should be paramount.

The central consideration in all payment design should be improving patient health outcomes, experience of care, and health equity, while also ensuring the most effective use of health care resources.

Measures of performance and impact should be meaningful, actionable, and transparent to consumers, patients and family caregivers.

New payment models should be assessed using measures that are meaningful to patients and families. They should prioritize the use of measures derived from patient-generated data that address both care experience and outcomes. Measures should also address the full spectrum of care, care continuity and overall performance of specific models. Measures should be granular enough to enable patients to make informed decisions about providers and treatments.

 

Primary care services are foundational and must be effectively coordinated with all other aspects of care.

Payment models should foster this coordination, particularly between primary and specialty care, in order to promote: optimal coordination, communication and continuity of care; trusted relationships between clinicians and patients/families; concordance with patient goals, values and preferences; integration of non-clinical factors and community supports; and coordination of services delivered through non-traditional settings and modalities that meet patient needs. Effective delivery and coordination of primary care services should promote better care experience, optimal patient engagement, better health outcomes, and increased health equity.

Health equity and care for high-need populations must be improved.

New payment models should foster health equity, including access to innovative approaches to care and preventing any discrimination in care. They should collect data that allows for assessment of differential impacts and the identification and redress of disparities in health, health outcomes, care experience, access, and affordability.

Patient and family engagement and activation should be supported by technology.

New payment models should promote use of information technology that enables patients and their designated caregivers to easily access their health information in a meaningful format that enables them to use the information to better manage and coordinate their care. The technology should also enable patients to contribute information and communicate with their providers, and it should foster patient-clinician partnership in ongoing monitoring and management of health and care.

Financial incentives used in all models should be transparent and promote better quality as well as lower costs.

Financial incentives for providers and patients should be fully disclosed so that patients and consumers understand how new payment approaches differ from traditional fee-for-service models, and how certain incentives may impact the care providers recommend or provide. Financial incentives should be developed in partnership with patients and consumers in order to reflect how patients define value, and to reduce financial barriers to needed care and ensure that patients are not steered to lower cost care without regard for quality.

To learn more visit: https://hcp-lan.org/groups/consumer-patient-affinity-group-cpag/

Click here to download the principles.

Young man taking blood pressureDoctor givind medsDoctor discussing records

To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.

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