Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced that it would be changing how it reimburses health care providers under Medicare in an effort to shift hospitals, physicians, pharmacists, and other providers’ focus from volume to quality and value.
Traditionally, many health care providers have received a payment for each individual service provided to a patient—including, for example, an initial physician consultation, health care screenings and tests, surgery, and follow-up care—often resulting in duplicative and unnecessary services, stagnant outcomes, and higher costs. However, under CMS’ new reimbursement model, the agency is aiming to encourage health care providers to better focus on the coordination of high-quality care by rewarding what works, rather than simply what services are provided.
And being able to measure what works and how well providers are performing under the value-focused model is vital to improving patient care and our overall health system, as Krystalyn Weaver, Director of Policy and State Relations for the National Alliance of State Pharmacy Associations, pointed out during a recent conversation with the National Pharmaceutical Council (NPC).
In fact, according to Ms. Weaver, “the more transparency we have of the quality [care] that’s being provided by certain health care providers, the better choices patients can make based on the value of care they can expect to receive for the cost that they’re paying.” And that’s a big deal, because by making patients better consumers of health care, we can not only ensure patients are more engaged in their care experience—which studies have shown can reduce readmissions and can improve the overall quality of care—but also reduce costs.
But—as Ms. Weaver shares—challenges remain when it comes to developing meaningful quality measures around certain key areas of care that contribute to outcomes, such as those related to the successful integration of technology and the coordination of care. Many health policy experts believe that better focusing on process measures, beyond those that simply lead to “box-checking,” may be the answer to truly transforming how we measure—and therefore provide—quality care for patients.
For example, during her discussion with NPC, Ms. Weaver explained that as pharmacists become more and more integrated into a patient’s health care team, “it’s going to be very important that we can measure [their] impact…and attribute the value that they bring to the team.”
Importantly, Ms. Weaver notes that despite the issues and challenges that exist in our health care system, “we can’t fix something that we can’t measure.” So as CMS works to incentivize health care providers to focus on value, instead of volume, quality measures will continue to play a key role in helping to ensure better outcomes for patients, while reducing unnecessary costs.