The healthcare consulting company Premier has released a detailed plan for improving the Affordable Care Act by focusing on patient-centered care that gives providers flexibility while holding them accountable for providing quality of care and a good experience for patients.
Blair Childs, senior vice president of public affairs at Premier, said the report was developed by several policy groups and is primarily intended for everyone involved in policy throughout the upcoming change in administration, regardless of who ends up in the White House.
“We're hoping it's going to stimulate thought and build additional momentum to continue what we think is a very positive movement in the healthcare system,” he said. “We want to make sure it continues in this transition.”
The 17-page report from Premier, which works with providers to help them embrace and implement payment reform, explains what the authors view as key problems with the current ACA structures. Childs said the authors wanted to take a holistic approach to the healthcare system.
One area targeted for improvement is accountable care organizations, which have attracted interest but still need a greater level of participation. It suggests a focus on allowing providers to more successfully implement clinical integration by loosening legal and regulatory barriers. It also proposes more flexibility in determining risk levels and adopting new payment waivers through legislative action.
The paper suggests modifying or eliminating some of the antitrust, anti-kickback and self-referral laws, which it argues are no longer necessary with value-based purchasing and alternative payment models. It also suggests legislation to create a single consolidated hospital pay-for-performance program.
The authors propose replacing reimbursement for primary care physicians with a single monthly capitated payment. This would allow them to optimize their use of care times and would avoid unnecessary referrals to specialists by adding a shared savings element.
It urges the CMS to make more data available to providers so that analytics lead to better performance under new payment models. The Office of the National Coordinator for Health Information Technology should improve the interoperability of electronic health records by requiring certified technologies to use standardized formats and open application programming interfaces, it states.
The report examines how to improve beneficiary engagement, such as by including measures that address patient perspectives on cost and outcomes in quality reporting programs and by incentivizing email and phone consults and in-home monitoring technologies.
To make it easier for rural providers to participate in value-based purchasing models, the report suggests a model specifically for critical access hospitals that would have a shared savings pool and focus on conditions like heart failure, acute myocardial infarction, diabetes, stroke, behavioral health and obesity.
Childs believes all the ideas proposed are achievable, reasonable policy changes that would create better incentives and reduce regulatory burdens.
“The more we move to making healthcare providers accountable, they're going to have to work much more effectively with consumers and their communities,” he said. “And you need payment structures that incentivize that. You need rules that allow it to occur.”
Republican candidate Donald Trump has said he would repeal the health reform law but has given little indication beyond standard conservative talking points about what he would put in its place. Democratic candidate Hillary Clinton has lauded President Barack Obama's signature healthcare law and said she would improve upon its success and work toward universal health coverage.
Childs said Premier staffers have already started discussing the paper with candidates's transition teams and members of Congress.
“We're very open to all direction and feedback from all quarters,” he said. “It's to begin a dialogue.”
Premier reported a jump in profits earlier this year that was attributed to growth in sales of its performance improvement technology and services. Company executives have also pointed to growth in the group purchasing business and an expected increase in demand for physician management and value-based payment reporting software.
The Premier report comes after a few weeks of particularly bad news for the ACA. Three major insurers have said they are drastically scaling back their participation in the exchange, which has left many coverage areas with only one or two companies offering plans. Also, another co-op failed, leaving only six of the original 23 currently in operation.
States have also been reporting requests for particularly large increases in premium rates, although HHS has insisted that consumers with premium subsidies will still be able to find affordable coverage.
Supporters of the law have also pointed to data released last week showing the highest rate of health insurance coverage in U.S. history.