Expanding access to value-based care
We believe that policymakers should encourage market innovations that promote value and place consumers in control of their own health care. A major component of this shift is promoting care in the lowest cost setting with health care professionals appropriately qualified and trained for the level of care needed. Treating non-urgent and minor ailments in retail clinics rather than hospital emergency rooms makes care more affordable and convenient for patients, while ensuring that high-cost settings are available for those who truly need them.
Expanding care settings for kidney patients: Only 12.5% of dialysis patients in the United States dialyze at home, despite its clinical, logistical, economic, and quality of life benefits. Our vision for transforming kidney care focuses on identifying patients at high risk of advancing to ESRD and offering them proven interventions; providing a “home-first” approach to dialysis care, as clinically appropriate; and expanding access to innovative and new patient-centric treatment options for ESRD.
Improving access to telemedicine: We support efforts that would make telemedicine an integrated component of the health care delivery system. In that spirit, we support efforts to break down barriers that inhibit Americans’ ability to conveniently use telehealth, where and when clinically appropriate.
Value-based arrangements for drugs: We support value-based purchasing arrangements for prescription drugs. These programs should be given explicit safe harbor protection so they can be expanded to not only the Medicare and Medicaid markets but also the commercial markets. Value based purchasing offers the opportunity to both lower costs and improve outcomes.
Explicit protection for health plan sponsors and pharmacies would make it easier to offer medication adherence and patient outcome-based arrangements, which assist health care providers in choosing the most cost-effective medications for their patients and to coordinate and improve access to care, which ultimately results in better health outcomes for patients.
Implementing actionable transparency: We support meaningful, actionable transparency such as real-time benefit tools and out-of-pocket cost calculator tools that help members choose the most cost-effective care. Publicly disclosing provider reimbursement rates and other price information under the guise of “transparency” will not help consumers identify their out of pocket costs or help inform their health care decisions. Instead, it will allow competitors insight into proprietary information and simply set a high floor for rates, ultimately increasing costs for consumers.