ACP issues proposal to realign health care delivery, reimbursement for greater equity

The College issued seven policy recommendations on reforming payment programs, including prioritizing underserved patient populations, addressing value in health care, and achieving greater equity.

A new ACP position paper, Reforming Physician Payments to Achieve Greater Equity and Value in Health Care,” makes a series of recommendations about how payment models should be redesigned to better account for social drivers that impact patient health.

The paper, published June 21 by Annals of Internal Medicine, offers seven recommendations:

  1. 1. ACP recommends that Medicare and other payers progressively adopt population-based, prospective payment models for primary and comprehensive care that are structured and sufficient to ensure access to needed care and address the needs of individuals who are experiencing health care disparities and inequities based on personal characteristics and/or are disproportionately impacted by social drivers of health.
  2. 2. ACP calls for research into creating a validated way to measure the cost of caring for such patients.
  3. 3. ACP recommends modifications to the Medicare law to establish a mechanism for savings to be calculated across all aspects of the program—that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced ED visits and hospitalizations (Part A)—and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services.
  4. 4. ACP recommends that the Secretary of Health and Human Services be authorized to address the inadequacies within the Quality Payment Program.
  5. 5. ACP believes that delivery and payment systems must fully support physicians, other clinicians, and health care facilities in offering all patients the ability to receive care when and where they need it in the most appropriate manner possible, whether that be via in-person visits, telehealth, audio only, or other means.
  6. 6. ACP recommends that adequate funding be made available to support the development of effective health information technology systems and communication mechanisms, including adequate broadband availability, to ensure that delivery and payment reforms are able to address the needs of all patient populations.
  7. 7. ACP recommends that federal and state policymakers and payers, health plans, health systems, private-sector investors, and philanthropic institutions develop and implement additional financing mechanisms beyond direct payment to clinicians and practices, such as grants and technical assistance, to support innovative approaches to address inequities, health care disparities, and social drivers of health.

“For more than a decade, policy goals have highlighted the need to achieve greater equity, yet the fact remains that execution of these policies continues to lag,” the paper concluded. “Now is the time to set a national intention to build on that experience and support implementation and assessment of payment approaches to advance health equity and overcome social drivers and other disparities that lead to poorer health outcomes.”