The current health infrastructure favors a fee-for-service (FFS) model which prioritizes quantity of medical services over quality of care or wellbeing. To improve patient outcomes and lower health care costs, Congress should consider investing in a high-value health care system: high-value health care system rewards coordinated and integrated health care, as well as addressing social needs that impact health. Addressing the social determinants of health (SDOH) is an integral component of a coordinated and holistic health care system – not a separate initiative. The Coalition actively supports policy solutions that work towards a high-value care system and addressing SDOH.
NCHC supports bipartisan solutions to promote a high-value health care system and SDOH, including
- Improvement to CMMI operations and model evaluation processes
- Increased upside incentives for providers to enter value-based arrangements
- Reductions in co-pays or expanded benefits for people with low-income and or chronic conditions
- Designing an “Essential Health Benefits” 2.0 that is responsive to high-value services, such as social services
- Innovative financing models for community social needs programs;
- Proposals to address mental health care shortages
- Flexibilities granted by Medicare Advantage that allow coverage of social services
- Comprehensive testing of SDOH interventions via section 1115 waivers or State Plan Amendments (SPAs)
- Community-based interventions and investments that improve care coordination and integration
Recent publications from NCHC on this topic:
June 16, 2020, John Rother, Katy Spangler, and Dr. A. Mark Fendrick
On June 15, NCHC’s John Rother collaborated with Katy Spangler, the Co-Director of Smarter Health Care Coalition, and Dr. A. Mark Fendrick, the Director of the University of Michigan Center for Value-Based Insurance Design, to publish an article in The Hill about high-value care amidst COVID-19.
May 8, 2020, NCHC Staff
Today’s health care institutions are stretched to capacity and beyond by the COVID-19 crisis. But like physical exercise, it’s possible that this stress can lead us to a stronger system longer-term. This depends, of course, on how we respond to the shortcomings revealed by our slow responses to the pandemic.
Read the full statement here.
December 20, 2019, Michael Budros
The future of value-based purchasing (VBP) is uncertain. Current models have theoretical promise, but critics point to minimal achievements. Despite the rhetoric around paying for value over volume, the percent of health care spending involved in pay-for-performance contracts has stagnated or declined. In addition, the polled enthusiasm among health care industry leaders for value-based purchasing is declining.
Read the full post here.
August 2, 2019, NCHC Staff
Governors and state legislatures have been taking action in 2019 to lower health care costs and promote affordable coverage options for their residents. We reviewed 2019 state legislation and executive actions, and highlight some of the boldest approaches to lower drug, provider, and health insurance costs.
Please click here to read the report in its entirety.
June 10, 2019, NCHC Staff
We recently expressed cautious support for the CMMI Geographic Direct Provider Contracting model in a letter to CMS. New opportunities for physician groups, health plans, and other organizations to partner to serve Medicare, and Medicare and Medicaid dual-eligible beneficiaries could bring new innovations in care delivery to more beneficiaries. As the number of alternative payment models grows, however, so does the complexity of attribution of outcomes and costs. In addition, the potential for confusion among beneficiaries increases as multiple organizations engage in outreach and marketing to describe their services.
To view the full letter, please click here.
January 8, 2019, NCHC Staff
On December 31st, 2018, the National Coalition on Health Care commented on CMS’ requirements for Medicare Advantage plans that offer additional telehealth benefits. NCHC noted that the “current limitations on the use of telehealth services are antiquated,” pointing to the fact that it was estimated that only 0.25 percent of Medicare beneficiaries were able to utilize telehealth services in 2016. Additionally, NCHC noted that the Veterans Administration (VA), has historically been able to benefit substantially from the use of telehealth care. To read the full letter and the commentary in its entirety, you can click here.
October 18, 2018, NCHC Staff
Dear Administrator Verma:
The National Coalition on Health Care appreciates the opportunity to comment on the proposed changes to the Medicare Shared Savings Program; Accountable Care Organizations–Pathways to Success
(CMS-1701-P). The National Coalition on Health Care (NCHC) is the largest, most broadly representative nonpartisan alliance of organizations focused on health care. The Coalition is committed to advancing—through research and analysis, public education, outreach, and informed advocacy—an affordable, high-value health care system for all stakeholders. Our members and supporters include more than 80 of America’s leading associations of health care providers, employers and unions, consumer and patient advocacy organizations, pension and health funds, religious denominations, and health plans.
This letter was originally sent to the office of Seema Verma on October 16, 2018. NCHC expressed its support for many aspects of the rule, but also shared some concerns.
April 16, 2018, NCHC Staff
Innovative payment models are changing the way healthcare is paid for and delivered in the United States—for the better. The transition to a value-based healthcare system, one where physicians, other health professionals, and health systems are rewarded for high-quality services that improve patient outcomes, is underway. Evidence shows that primary care can help us live longer, healthier lives and can save our healthcare system $13 for every $1 spent. As the healthcare sector shifts toward rewarding value over volume, primary care should be at the heart of our efforts to promote simplicity, coordination, and affordability.
Read the full op-ed here.
March 15, 2018, NCHC Staff
The National Coalition on Health Care (NCHC), the nation’s oldest, largest most diverse health care coalition, praised the announcement today of a new bipartisan Health Care Innovation Caucus, co-chaired by Rep. Mike Kelly (R-PA), Rep. Ron Kind (D-WI), Rep. Markwayne Mullin (R-OK), and Rep. Ami Bera (D-CA).
Read the full statement here.
February 20, 2018, John Rother
Today health care is not achieving its potential for individuals or the population as a whole. However, it seems that some large purchasers of health care are now ready to reject this model.
As a long-time advocate for older Americans and now leader of an organization representing health care providers, payers, and purchasers, I am increasingly optimistic that we can make significant progress, despite political gridlock.
You can find the full op-ed here.
February 2, 2018, NCHC Staff
Dear Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:
We write on behalf of some of the most vulnerable Medicare seniors, disabled and critically ill patients across America who are now facing serious health care consequences if Congress does not pass a Medicare legislative package soon. There is strong bipartisan support in both houses of Congress for a Medicare legislative package to retroactively address Medicare extenders, and refine other reimbursement and coverage issues directly related to the health and well-being of Medicare beneficiaries.
Find the full letter here.
February 8, 2018, NCHC Staff
Dear Senators Thune and Carper and Representatives Black and Blumenauer:
On behalf of the Smarter Health Care Coalition (Coalition) and the undersigned organizations, we are writing to applaud the Chronic Disease Management Act of 2018. This critical legislation will help patients with chronic conditions access high-value health care services and medications that ensure optimal health and well-being.
This letter was originally organized and sent by the Smarter Health Care Coalition. To see the citations and full list of co-signers, please see the PDF version here. To see the press release from the Smarter Health Care Coalition, please click here.