Search

Better Value

 

High value simply means getting the highest quality care at the most affordable price. To achieve high-value health care, we must fix our payment system to reward providers for giving the right care at the right time in the right way. The Consumer-Purchaser Alliance advocates for payment strategies that reward value over volume, and the creation of incentives for care that result in better outcomes.

We need a system that provides the highest quality care at an affordable cost, and consumers and purchasers need information about the quality of care to determine the value they are getting for the dollars they spend. The Consumer-Purchaser Alliance is a constant advocate for value, promoting this goal in all of our work, including through advocacy meetings, webinars, op-eds, and comment letters.

Recent efforts have included advocating for the new health insurance exchanges to promote value as anticipated by the Affordable Care Act. The Consumer-Purchaser Alliance has engaged in multiple meetings with the Department of Health and Human Services and the White House, and authored op-eds and comment letters urging exchanges to provide comparative information on the quality and value of participating health plans and align their effort with other purchasers.

November 24, 2014

Every year CMS releases proposed rules on their hospital inpatient and ambulatory payment programs and C-P Alliance organizes a response from our participants.  This year, we had 33 unique consumer and purchaser organizations sign on to the two letters.  C-P Alliance has reviewed the recently released final rules by CMS for FY 2015.  The programs in the inpatient hospital arena have made more progress than programs impacting ambulatory services, partly because it was the first area to establish value purchasing.  We see a greater emphasis on the use of outcome measures and a trend towards moving away from low value measures (e.g., “topped out” or documentation process measures). The measures in the outpatient arena trail much further behind. Opportunities do exist, however, to address persistent measure gaps in the outpatient and ambulatory surgical center settings through the refinement of existing measures.  While inpatient programs have made more progress, are disappointed that the pace of progress has slowed for Readmissions and HAC Reduction programs.  In terms of payment incentives, most inpatient programs have small incentives (e.g., 1% of payment) but collectively add up across programs (e.g., 7-10%).  Notably, many programs are designed so only a small group of providers experience the maximum penalty and more receive incentive payments.  

Click here for the Inpatient Hospital FY 2015 analysis

Click here for the Outpatient Hospital and Ambulatory Surgery Centers FY 2015 analysis

 
The Results Are In: Promising Performance among Pioneer ACOs Despite Inevitable Challenges

In this Health Affairs blog, CP Alliance Co-Chairs reflect on the encouraging results from the first year of testing Accountable Care Organizations (ACOs), including evidence of improved quality and reduced costs.August 6, 2014

 

The Consumer-Purchaser Alliance has expressed concern about a recent Kaiser Capsule article and the negative light the article puts on the success of the Hospital Value-Based Purchasing program. Considering the resource-intensive systems and culture redesigns many of these hospitals are employing to improve their outcomes in response to the VBP program, we think the nine month evaluation period used in this study does not give due credit to the large-scale changes that are happening at the ground level. As all measures in the VBP are initially included in the Inpatient Quality Reporting (IQR), it would be useful to consider the role that program plays in improvement (e.g., assessing progress from initial inclusion in IQR).

The article briefly highlights the Hospital Readmissions Reduction Program (HRRP) as another facet of the ACA – this program is a bit more mature than the HVBP and has demonstrated positive results over the years. The Centers for Medicare & Medicaid Services (CMS) reported that the 30-day, all-cause readmission rate dropped to 17.8 percent in 2012 after averaging 19 percent for five years. This translated into 70,000 fewer readmissions. This change supports the notion that linking financial incentives to standardized quality metrics has and will continue to drive significant improvements in patient outcomes and reduce unnecessary costs to the system. Furthermore, the average hospital was fined less in the second year of the Medicare Readmissions Program than in the first. The total national penalty was $53 million less despite increasing the percent reimbursement “at risk” – showing that hospitals are making real progress in improving care and are able to do so even considering the financial obligations applied by this particular federal program. 

The goal of these provisions of the health law are to move away from fee for service and toward reimbursement models that reward quality, value, and improved health outcomes.


Hospital Readmissions Programs: Are they Working?
The Wall Street Journal published CP Alliance co-chair Bill Kramer’s letter on hospital readmissions in the Affordable Care Act. In the letter, he argued that a recent critique of Medicare’s hospital readmissions program overlooked that the program is working.

 

May 6, 2013
CP Alliance Calls for More Meaningful Health Insurance Exchange Navigator Standards
CP Alliance submitted comments to CMS in response to the proposed rule for implementing the Health Insurance Exchange Standards for Navigators and Non-Navigator Assistance Personnel. In the letter, which includes the support of 21 consumer and purchaser organizations, CP Alliance makes recommendations regarding the inclusion of quality data in the Navigator certification standards and training modules. CP Alliance also comments on the need for strong oversight of provider organizations that become certified Navigators, and the need for all Navigators, whether or not they are funded with Federal grant money, to be held to the same certification and training standards.

 

May 6, 2013
Setting the Framework for Pursuing Health Care Quality
The Consumer-Purchaser Alliance Co-Chair, Bill Kramer, completed an issue brief on health care quality, What Do We Say When We Talk About Health Care Quality? This publication sets the groundwork for a meaningful discussion on creating a parsimonious set of core measures that are meaningful and useful to providers, patients, health plans, and purchasers.

 

January 14, 2013
CP Alliance Calls for Strong Quality and Cost Reporting in Health Insurance Exchanges (now "Marketplaces")
The Consumer-Purchaser Alliance responded to a Request for Information on quality reporting in the Exchanges with a letter to CCIIO, signed by 24 consumer and purchaser organizations. The comments advocated strongly for having meaningful quality reporting available to consumers beginning in October 2013, arguing that public reporting of quality and cost information are integral to the program's success. The comments also included examples of national and state reporting sites that should be viewed as models for how to provide transparent performance information.

 

September 5, 2012
CP Alliance Calls for More Robust Medicare Physician Fee Schedule Programs
The Consumer-Purchaser Alliance is urging the Medicare program to strengthen its efforts to improve the quality of physician care for the nation's 47 million Medicare beneficiaries. In a letter to CMS, 28 consumer, labor, and purchaser organizations said stronger quality measurement and public reporting programs are essential to creating a system of care that rewards better care, higher value, and more coordination of care instead of the volume of services provided.

 

December 14, 2011
Discussion Forum on Cost and Resource Use Part II: Utilizing Cost and Resource Use Measures in Payment and Public Reporting Programs
The agenda is available here.
A recording of this discussion forum is also available.
Consumer-Purchaser Alliance Opening remarks
Debra L. Ness, President, National Partnership for Women & Families
William Kramer, MBA, Executive Director National Health Policy, Pacific Business Group on Health
Innovative Models for Accountable Care
Paul Handel, MD, Sr. Vice President and Chief Medical Officer, Health Care Service Corporation
Leveraging Transparency to Improve Quality and Lower Cost
Robert Greene, MD, Vice President of Clinical Analytics, United Health Care Clinical Services
All-Payer Claims Databases: State Progress and Future of APCDs
Denise Love, Executive Director, National Association of Health Data Organizations
How Do Consumers Respond to Comparative Cost and Resource Use Information?
Shoshanna Sofaer, Dr. P.H., Professor and Chair of Health Care Policy, Baruch College/CUNY

 

November 17, 2011
Discussion Forum on Cost and Resource Use Part I: Understanding How Cost and Resource Use are Measured
Resources and Background Materials
A recording of this discussion forum is also available.
Consumer-Purchaser Alliance Opening Remarks
Debra Ness, President, National Partnership for Women & Families and Co-Chair, Consumer-Purchaser Alliance
Bill Kramer, Executive Director National Health Policy, Pacific Business Group on Health and Co-Chair, Consumer-Purchaser Alliance
Total Cost of Care & Total Resource Use Overview
Sue Knudson, Vice President, Health Informatics at HealthPartners, Inc.
Episode-Based Cost and Resource Use Measurement
Mark Rattray, MD, President at CareVariance, LLC.
An Overview of NCQA's Relative Resource Use Measures
Phyllis Torda, Vice President, Strategic and Quality Solutions Group at National Committee for Quality Assurance Relative Resource Use

 

September 4, 2012
Consumers and Purchasers Ask CMS to Make the Medicare Hospital Outpatient and Ambulatory Surgery Center Quality Reporting Programs More Meaningful
In a letter to CMS, 27 consumer, labor, and employer organizations expressed their concern that there was little effort made in this year's Outpatient Prospective Payment System (OPPS) proposed rule to expand and improve upon the Outpatient and Ambulatory Surgery Center Quality Reporting Programs (OQR and ASCQR respectively). The organizations provided CMS with suggested measures that would support the recommendations made by the Measure Applications Partnership (MAP), including additional clinician-based measures as well as measures related to supporting better health in communities, making care more affordable, and person- and family-centered care.

 

August 22, 2012
Saving Lives and Dollars by Reducing Preventable Readmissions
Every year, Medicare spends about one-third of its budget on paying for hospital admissions. Reducing readmissions requires all stakeholders to work together, including hospitals, other healthcare providers, communities, and patients and their families. Consumer-Purchaser Alliance co-chairs Debra Ness and Bill Kramer explain where we have made progress, and how we can take the next steps in this blog post.

 

June 25, 2012
CP Alliance Comments on Proposed Rule for the Medicare Inpatient Prospective Payment System (IPPS)
Enhancements to the Inpatient Quality Reporting (IQR) program will integrate quality metrics to identify and drive better health, better care, and lower costs. Although generally in support of the overall direction of the proposed rule, CP Alliance submitted this comment letter urging increased alignment with other purchasers' value-based efforts. In addition, CP Alliance supported the measures proposed by CMS while cautioning against the wholesale removal of granular patient safety information.

 

June 18, 2012
CP Alliance comments on Federally Facilitated Exchanges (FFE) General Guidance Document
Due to the significant number of states that are unlikely to have a state Exchange established by the deadline, it is likely that an FFE will be established in a significant number of states to ensure that all Americans have access to a marketplace for purchasing affordable, comprehensive individual health coverage. The CP Alliance submitted this letter, urging HHS and CCIIO to strengthen the language in the FFE guidance to ensure that meaningful quality and cost information will be made available to consumers in time for the FY 2014 start date.

 

May 25, 2010
Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs
Resources and Background Materials
Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs
David Lansky, Co-Chair, Consumer-Purchaser Alliance and President and CEO, Pacific Business Group on Health
Models of Accountable Care: Medical Home, Episodes and ACOs – Making it work
Elliot Fisher, Director, Population Health and Policy, The Dartmouth Institute for Health Policy and Clinical Practice
Accountable Care Organizations: Taking Shape at the Local Level
Development of Vermont ACO Pilots: Community Health Systems To Control Costs and Improve Health
Jim Hester, Director of the Health Care Reform Commission in Vermont
ACOs: A Health Plan Perspective
Kirk Stapleton, Sr. Vice President, Network Planning UnitedHealth Networks
Federal Implementation/Reaction
Jon Blum, Director, Center for Medicare Management, Centers for Medicare and Medicaid Services (no PowerPoint slides)

 

March and April, 2012
CP Alliance Comments on a Variety of NCQA Programs
The National Committee for Quality Assurance (NCQA) recently closed a comment period for their Physician and Hospital Quality Update. CP Alliance submitted comments that were overall supportive with some suggested modifications. NCQA also solicited comments on their proposed update to the NCQA Accreditation and Certification Process. In its comments, CP Alliance pointed to the opportunity for NCQA to align with federal quality reporting requirements for qualified health plans operating in the Exchanges. Finally, NCQA solicited feedback on their proposed Technical Specifications for ACO Measures. CP Alliance submitted comments that called for more innovation in the measure dashboard and reporting at the provider level (in addition to aggregate ACO).

 

January 28, 2010
Shared Decision Making's Place in Health Care Reform
These slides were presented at the Foundation for Informed Medical Decision Making Research and Policy Forum, held in Washington D.C. on January 28, 2010.
Slide Presentation: Peter V. Lee, Executive Director for National Health Policy, Pacific Business Group on Health

 

January 13, 2012
CP Alliance weighs in on Medicare Advantage Quality Bonus Payment
In 2012, the Centers for Medicare & Medicaid Services (CMS) starts its three-year Medicare Advantage Quality Bonus Payment (QBP) demonstration to financially reward Medicare Advantage (MA) plans that provide high-quality care. The demonstration will also make information on the quality of MA plans available on the Medicare Plan Finder website, with quality indicated via a star rating system. Recently, CMS sought input on QBP's methodology and measures. In a move that supports greater transparency, the agency proposed adding quality measures that extend beyond health plans to hospitals and other settings. In a letter, CP Alliance encouraged CMS to leverage QBP to fulfill Congress's intent for MA plans: to operate more efficiently than traditional Medicare fee-for-service plans, without sacrificing quality. CP Alliance stated that new measures for the star rating system should be meaningful for consumer-decision making and drive plans to pursue high-value care, including those focusing on mortality, readmissions, and patient safety.

 

January 2012
Effort to Drive Value-Based Purchasing
One of the core priorities of the Consumer-Purchaser Alliance is to promote alignment, across public and private sector purchasers, of strategies and tools for accomplishing value-based purchasing (VBP) that improves health care quality and bends the ever-rising cost curve. While both CMS and private purchasers currently use innovative VBP tools, there is very little cross-fertilization across private sector purchasers, or between the public and private sectors. To better leverage the progressive work being done and share best practices, we are excited to announce a new Value-Based Purchasing Initiative composed of the nation's leading business groups on health, consumer organizations, several large employers and union health funds. Funded by The Robert Wood Johnson Foundation, the Initiative will conduct outreach and provide assistance to private purchasers to enable a change from fee-for-service, volume-based payment model, to one based on value. CP Alliance is assisting with the overall coordination of the project. In its first phase, the Initiative will develop and make available tools to help private purchasers work with each other, as well as with Medicare, to promote and implement successful VBP. These tools will include (1) a request for information to acquire standardized health plan information that purchasers need in order to implement VBP; (2) creation of a web-based data platform to collect information on VBP methods, measures and contract language; and (3) an analytical review of VBP payment methods already in use; and (4) a paper summarizing federal antitrust guidelines that may affect purchasers' efforts to work together, to enable purchasers to pursue their efforts most efficiently and effectively.
Please check back here for updates on this new project, and click here to view documents related to the issues being tackled by this project.

 

October 31, 2011
Consumers and Purchasers Comment on Proposed Rules for New Health Insurance Exchanges
In July, HHS released a proposed rule beginning the process of developing guidance to the states as they develop the Affordable Care Act-mandated Health Insurance Exchanges for individuals and small businesses. In response to the proposed rule, 23 consumer and employer organizations submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS). The comments reflect their support for HHS to require states to incorporate strong quality, cost and value information in their consumer assistance tools, including the web portals and cost calculators. The letter also discusses the need for strong consumer and purchaser representation on the Exchange governance boards, and the need for meaningful conflict of interest rules to ensure that those who govern the Exchanges do so with consumers' and employers' needs in mind. Finally, the comments discuss the need for Small Business Health Options Program (SHOP) exchanges, which will provide new choices for employees of small businesses beginning in 2014, to include the same level of quality and cost information for consumers. In addition to the comment letter, the Consumer-Purchaser Alliance held an informational webinar on the topic of Exchanges, based on the comments being submitted. For just the slides from this webinar, click here.

 

September 15, 2011
Getting "Good Value" Health Care
David Hopkins, Ph.D., Senior Advisor to PBGH and the Consumer-Purchaser Alliance joined community members in Humboldt County to launch Care About Your Care, a month-long effort to raise awareness about what consumers can do to identify and get better health
care. In this presentation, Dr. Hopkins discusses the tenuous connection between cost and quality in our current health care system and explains how more care, and more expensive care isn't always better care. Dr. Hopkins offers practical advice for consumers, providers, health care leaders and community leaders about how they can improve the quality and affordability of health care in this country.

 

September 2011
Health Insurance Exchanges: Vision and Principles
How Exchanges are established will determine to what extent they become vehicles for improved quality, reduced costs, and expanded coverage. First, criteria used by exchanges can ensure that the individual and small group Exchange markets include only the highest value plans. Second, Exchanges can actively engage consumers and purchasers of care in plan selection by providing objective measurement information and tools for evaluating choices according to priorities. Third, Exchanges may mobilize its purchasing power to pull market levers, incentivize changes in provider and institutional behaviors, and improve value in the health care delivery system. To better inform its members, in September, CP Alliance developed "Health Insurance Exchanges: Vision and Principles," which lays out practical information on vision, governance, functions, quality improvement initiatives, consumer assistance tools, cost calculators, navigator program standards, small business health options program (SHOP) exchanges, and various other standards.

 

August 30, 2011
Consumers and Purchasers Commend Proposed New Rules Affecting Quality of Care Delivered in the Medicare Outpatient and Ambulatory Surgical Center Settings, and the Hospital Value-Based Purchasing Program
In a letter to the Centers for Medicare & Medicaid Services (CMS), 28 consumer, labor, and employer organizations voiced their strong support for proposed regulations to outpatient and ambulatory surgery center quality reporting programs. The organizations expressed support for measures on patient safety, outcomes, and diabetes care. For the new Hospital Value-Based Purchasing Program, organizations strongly supported CMS' proposal to make outcome measures count for 30 percent of hospitals' total scores and reducing the weight given to clinical process measures. The proposed rule can be found here.

 

August 30, 2011
Consumer-Purchaser Alliance advocates for CMS to set higher standards for how physicians are rewarded and evaluated
In a letter to the Centers for Medicare & Medicaid Services (CMS), 29 consumer, labor, and purchaser organizations urged the agency to strengthen the proposed Physician Fee Schedule by being bolder in paying physicians for value and assessing performance. They recognized the agency's recent strides in both areas and call for changes that will have a significant and lasting impact on bending the cost curve and improving quality.

 

June 6, 2011
Consumers and Purchasers Applaud Proposed Rules for Medicare Shared Savings Program and Provide Recommendations for Monitoring Anticompetitive Behavior
Transformational programs are critical to addressing the quality and affordability crisis that Americans experience with our health care system. Accountable Care Organizations (ACOs), if done "right," can be one of those programs. On June 6, 2011, the Consumer Consumer-Purchaser Alliance – with 25 signatories – applauds CMS' proposed rule on Medicare Shared Savings Program for ACOs and urges the agency to take further steps to ensure that ACOs provide health care that is patient-centered, high quality and affordable. The Consumer-Purchaser Alliance also urges CMS to include additional provisions to keep the health care marketplace competitive. Last week the Consumer-Purchaser Alliance sent a letter with 22 signatories to the Federal Trade Commission and the Department of Justice in response to their proposed antitrust guidelines for ACOs.

 

March 21, 2011
The National Quality Strategy, Charting a Unified Course for Improving Health Care Quality
The Department of Health and Human Services (HHS) submitted the National Quality Strategy (NQS) to Congress on March 21, marking the creation of the first national plan for how to improve the quality of health care. The NQS importantly identifies better coordination and communication, patient-centered care, public reporting of provider performance, and cost containment as keys to improving the health care system. CDPD is pleased to see that the comments it submitted in October 2010 on the draft strategy are reflected in this first plan. We believe what was released is an important step towards a unified quality strategy, and we look forward to continued collaboration with the Administration in further refining the strategy and developing concrete goals. CP Alliance's statement on the NQS is available here.

 

March 18, 2011
CP Alliance Comments on CMS' Proposal to Curb Payment for Preventable Care-Related Conditions
In a letter to CMS, CP Alliance supported CMS' proposal to expand the current Medicare Hospital Acquired Conditions (HAC) non-payment program to include provider-preventable conditions (PPCs) and health care acquired conditions (HCACs) in the Medicaid program. In addition to supporting the proposed non-payment events, CP Alliance recommended additional conditions and measures for the program, improving the public reporting framework, and ensuring that payment methodology does not impede access to care.

 

March 8, 2011
Basing Medicare Hospital Payment on Performance
Twenty-eight consumers and purchasers voiced their strong support of CMS' proposal to begin tying Medicare hospital payments to how well hospitals care for their patients. They encouraged CMS to reward hospitals for high levels of performance, give greater weight to patient experience in determining payments, focus on measures that are meaningful to consumers and purchasers, and set an aggressive timetable for increasing the amount of payment that is based on performance.

 

December 3, 2010
Weighing in on CMS' Implementation of Accountable Care Organizations (ACOs)
The Consumer-Purchaser Alliance submitted a comment letter in response to questions posed by the Centers for Medicare & Medicaid Services on Accountable Care Organizations (ACOs). CP Alliance advocated for ACOs to be evaluated on a core set quality and cost measures. We also recommended CMS work in partnership with the private sector to result in greater change.

 

November 19, 2010
Setting Standards for ACOs
CP Alliance commented on NCQA's proposed ACO Criteria for 2011. If done right, ACOs could increase quality and affordability of care. We encouraged NCQA to strengthen its standards around performance measurement and cost containment to help assure these aims are achieved.

 

October 15, 2010
Building a Comprehensive National Health Care Quality Strategy and Plan
In a comment letter to Secretary of Health and Human Services Kathleen Sebelius, 27 consumer, labor, and employer organizations applauded the agency's proposed National Health Care Quality Strategy and Plan. At the same time, the signators also provided guidance on how the Strategy can be strengthened, by clarifying the framework around which the strategy is built, including specific targets for improvement (both aspirational and short-term), emphasizing the need for cost containment, and generally reflecting priorities and tactics that are central to high-value care. The Strategy will play an important role in guiding the public and private sectors in their efforts to improve health care quality across the nation. In accordance with the Affordable Care Act, HHS will finalize the Strategy and deliver it to Congress by January 2011.

 

October 4, 2010
Comments to HHS on Health Insurance Exchanges
In accordance with the Affordable Care Act, Americans will be able to purchase coverage through national and state health insurance Exchanges starting in 2014. In response to the Department of Health and Human Service's request for input on how Exchanges should be implemented, CP Alliance, in its comment letter, urged the federal government and states to require that Exchanges be "active purchasers." As active purchasers, Exchanges would not only expand coverage but serve as vehicles for transforming the delivery system and lowering health care costs.

 

August 31, 2010
Comments on CMS' proposed changes to the Hospital Outpatient Prospective Payment System
In a comment letter to CMS, 27 consumer, labor, and employer organizations supported the agency's plans to improve quality reporting in the hospital outpatient setting. Over the course of the next few years, CMS expects to expand the number of measures being reported by hospital outpatient facilities with a focus on many areas that are important to consumers and purchasers (e.g., overuse, efficiency, care coordination and transitions). CP Alliance also developed a backgrounder on the proposed changes.

 

August 24, 2010
Comments to CMS on Medicare Physician Payment for 2011
Twenty-four consumer, labor, and employer organizations urged CMS to take bolder strides in transforming physician payment. They underscored the need to rapidly develop robust foundations for value-based purchasing -- effective measurement, data collection, and reporting. They also emphasized the importance of reforming how physician services are valued so they reflect the perspectives of patients and society as a whole. Read comments.

 

July 2, 2010
Setting Standards for Medical Homes
CP Alliance commented on NCQA's proposed Patient-Centered Medical Home Standards for 2011, which serve as a standardized tool for assessing whether physician practices have the systems and processes in place needed to support a patient-centered medical home (PCMH). Our comments appreciate the significant progress NCQA has made in enhancing its standards, but also underscore the importance of improving them to make patient experience and meaning use "must pass" elements to receive recognition for having the capabilities of a PCMH.

 

June 18 , 2010
Expanding Hospital Quality Measurement and Public Reporting: Comments to CMS on Proposed Changes to the Inpatient Prospective Payment System Proposed Rule
In response to proposed changes to the IPPS Proposed Rule's pay-for-reporting program (often referred to as "Reporting Hospital Quality Data for Annual Payment Update," or RHQDAPU) for 2012 - 2014, 30 consumer, labor union, and employer organizations affirmed their support for an expanded set of required quality measures. In addition to commenting on the measures being proposed, the comments addressed a range of important issues, including criteria for removing measures from the program, and the addition of measures that rely on registry data, which until now have not been included in RHQDAPU. Read Comments.

 

June 17, 2010
Creating a Framework for Improving Care for Individuals with Multiple Chronic Conditions
HHS released a draft Strategic Framework on Multiple Chronic Conditions to support a coordinated vision and plan of action on how to improve care for individuals with multiple chronic conditions. CP Alliance provided comments applauding HHS' efforts to create a framework to address the unique needs experienced by this population. The comments also expressed the need to strengthen the framework by maximizing the contributions of health information technology and performance measures.

 

September 9, 2009
Comments on CMS' Proposed Changes to the Medicare Physician Fee Schedule and PQRI Program
In response to CMS' proposed changes to the Physician Fee Schedule and PQRI program, 23 consumer, labor, and purchaser organizations affirmed their support for comments that reflected concerns that CMS' proposed payment changes to the PFS for 2010 are not deep or wide enough to promote the transformation of the health care system into one that incents high-quality, high-value and patient-centered care. While many changes do require Congressional action, we specifically encourage CMS to rapidly pursue an agenda where the following are top priorities:

  • Adopting payment systems that encourage physicians and other providers to work together to improve care
  • Making payment decisions based on the perspective of consumers and purchasers, rather than sole reliance on resource costs
  • Shifting payments to reward performance instead of volume of care and reporting on care quality
  • Ensuring comprehensive collection and reporting of physician performance data, which is critical to helping payers reward physicians for quality and value of care, and providing consumers with information they need to make better decisions about their care

Read comments

August 31, 2009
Comments on CMS' Proposed Changes to the Outpatient Prospective Payment System Rules
In response to CMS' proposed changes to the OPPS rule for CY 2010, 17 consumer, labor, and purchaser organizations have affirmed their support for comments submitted by the Consumer-Purchaser Alliance regarding the direction that they would like to see the Hospital Outpatient Program Quality Data Reporting Program take.
Read comments

 

June 30, 2009
Comments on CMS' Proposed Changes to the Inpatient Prospective Payment System Rules
In response to CMS' proposed changes to the IPPS rule for 2011, 23 consumer, labor, and purchaser organizations have affirmed their support for four additional quality measures to be added to the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, as well as reiterating their concern that CMS focus on adding measures related to health care outcomes and other measures that are meaningful to consumers and purchasers.
Read comments.

 

May 15, 2009
Comments on Senate Finance Committee Delivery System Reform Options
The Senate Finance Committee released a report on Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs, the first in their three-part series on reform. CP Alliance submitted a letter strongly supporting the direction of reforms that were outlined, provided recommendations on the policy options, and identified some cross-cutting areas that were not addressed in the report.

 

May 5, 2009
Comparative Effectiveness Research: Understanding What It Is and Helping to Shape the Future Course
Resources & Background Material
Comparative Effectiveness Research in the Context of Health Care Reform
Peter Lee, Consumer-Purchaser Alliance and Pacific Business Group on Health
Comparative Effectiveness Research: Key Issues and Controversies
Steven Pearson MD, MSc, FRCP, Institute of Clinical and Economic Review
Using Comparative Effectiveness Research in the Public and Private Sector
Sean Tunis MD, MSc, Center for Medical Technology Policy

 

April 2009
Issue Brief: Historic Expansion of Quality Measurement in Medicaid and CHIP
On February 4, 2009, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), ensuring continued and potential expansion of health coverage for 11 million children through September 30, 2013. The continuation of the program is itself major news, but the act also included some very significant provisions to improve quality that will help advance the agenda for performance-based health reform. For the first time, states will be required to report annually to the Secretary of the Department of Health and Human Services (HHS) on the quality of health care that children are receiving in both Medicaid and CHIP. This issue brief describes the state of quality reporting in Medicaid and CHIP, including important a timeline of important dates for advocacy activities in this area.

 

March 6, 2009
National Health Care Reform Promoting Better Quality and More Affordable Care: Major Options and How to Translate Them for Beyond the Beltway
National Health Care Reform: Policy Options that Can Promote Affordability and Higher Quality
Debra L. Ness, Co-Chair, Consumer Consumer-Purchaser Alliance and President, National Partnership for Women & Families
Peter V. Lee, Co-Chair, Consumer-Purchaser Alliance and Executive Director for National Health Policy, Pacific Business Group on Health
Voter Attitudes on Health System Change Reforms
Lake Research Partners and The Herndon Alliance
Materials on Messaging Health Reform
Key Messaging Lessons About System Changes in Health Care Reform
This memo from The Herndon Alliance and Lake Research Partners provides key findings and top messages on reform issues such as comparative effectiveness, evidence-based medicine, and overuse.
Quality and Equality in U.S. Healthcare: A Message Handbook
A recent publication from The Robert Wood Johnson Foundation, this handbook was created to provide the Aligning Forces for Quality (AF4Q) communities with information and messaging on a range of reform policy strategies, including consumer engagement, quality improvement, rewarding quality care, and performance measurement and public reporting.
From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect
This study examines how the language of health policy and reform commonly used by stakeholders actually gets "heard" by the lay public, with some surprising results.

 

February 2009
CMS Releases "Roadmaps" on Quality Measurement, Resource Utilization, and Value-based Purchasing
In the "good news" category, we are pleased to let you know that CMS has released three "roadmap" reports, describing how the agency will move forward over the next three-to-five years in the areas of quality measurement, resource utilization measurement, and value-based purchasing. A summary of these reports (with links to the roadmaps embedded within) can be accessed here. While many of the initiatives, strategies, and goals that CP Alliance and its members have been advocating are included in the documents, there are some areas that will need continued advocacy efforts.
Full Document

 

January 12, 2009
National Health Care Reform: The Odds, the Players, and the Issues
This briefing provides an overview of how the new administration's attempt at passing a broad health care reform package may proceed. The briefing will include discussion of the elements of health care reform, who will be shaping the reform in Congress and the Administration, and the theory and reality of the process. This briefing is the first part of a two-part series, and will be followed by a more in-depth examination of the elements of the health care reform package in February.
Slide presentation: Peter V. Lee, Executive Director for National Health Policy, Pacific Business Group on Health

 

December 16, 2008
Comments on Plan to Transition to a Medicare Value-Based Purchasing Program for Physician and Other Professional Services
Twenty consumer, labor, and purchaser organizations affirmed the goals, objectives, and assumptions outlined in the Issue Paper developed by CMS. The organizations also strongly requested that CMS actively coordinate and align with private sector initiatives and provided suggestions in the areas of measurement, incentives, data, and public reporting. Read comments

 

September 4, 2008
Medicare Improvements for Patients and Providers Act (MIPPA) of 2008
This briefing provides an overview of the Medicare Improvements for Patients and Providers Act (MIPPA), voted into law on July 15, 2008, as well as insight into the political context surrounding its enactment, and what it means for future reform efforts around quality and transparency.
Slide Presentation: Debra L. Ness, President, National Partnership for Women & Families and co-chair, Consumer-Purchaser Alliance
Slide Presentation: Billy Wynne, Health Policy Counsel, Senate Finance Committee
MIPPA Legislation: H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008

 

June 13, 2008
Comments on CMS' Proposed Changes to the Inpatient Prospective Payment System Rules
In response to CMS' proposed changes to the IPPS rule, twenty-five consumer, labor, and purchaser organizations have affirmed their support for 9 additional Hospital Acquired Conditions (HACs) to which non-payment policies would apply, as well as an additional 43 quality measures to be implemented by FY 2011. The Consumer-Purchaser Alliance also commented on a number of other data collection issues, as well as issues related to CMS' Medicare Hospital Value-Based Purchasing Program. Read comments

 

March 5, 2008
Comments on CMS' Report to Congress, Plan to Implement a Medicare Hospital Value-Based Purchasing Program
In response to CMS' Report Plan to Implement a Medicare Hospital Value-Based Purchasing Program that was delivered to Congress towards the end of last year, thirty-one consumer, labor, and purchaser organizations have affirmed their support for hospital pay-for-performance and it being one component of more substantial payment reform. Under the Deficit Reduction Act of 2005, CMS was required to submit a report to Congress on developing a plan for hospital value based purchasing. Implementing the plan, however, requires further action from Congress. Read comments

 

October 17, 2007
The Medical Home and Physician Payment Reform
Resources & Background Material
The Medical Home and Physician Payment Reform
Resources and Background Materials, October 2007
Overview of the Medical Home and Physician Payment Reform
Peter Lee, Consumer-Purchaser Alliance
The Patient Centered Medical Home: A New model for Primary and Principal Care
John Tooker, Executive Vice President and Chief Executive Officer of the American College of Physicians (ACP)
Patient-Centered Medical Home: Knowing When We See One
Greg Pawlson, Executive Vice President of the NCQA
Medical Home Demonstrations: Rhode Island Experience
Deidre Gifford, Chief of Health Policy and Programs at href="http://www.riqualitypartners.org/">Quality Partners of Rhode Island
Medical Home Demonstrations: Private Health Plan
Lisa Latts, Vice President, Programs in Clinical Excellence for WellPoint, Inc.
Medical Home Demonstrations: CMS and Federal Initiatives
Linda Magno, Director of the Medicare Demonstrations Group in the Office of Research, Development and Information at the Centers for Medicare and Medicaid Services

 

October 2007
Ensuring High Quality, Affordable Health Care
There is wide variation in the quality of health care available to Americans, and that the variation in care has significant costs in lives and dollars. One of the ways to bridge the gap between the care that people receive and what the health system is capable of delivering is through performance measurement and reporting initiatives - ones that are meaningful for consumers and purchasers, as well as for those being measured. Transparent, public information not only encourages consumers to consider quality and cost-effectiveness in their health care decisions, but also guides effort to improve outcomes and slow the rise of health care costs. In the absence of quality measurement and information, patients suffer the most.
Below are "fact sheets" that summarize critical elements for improving quality and affordability as well as potential solutions to make our health care system work well for those it serves. We hope that you will download them to learn more about these issues, and use them when you talk to policy makers, opinion leaders, and other stakeholders about the need for reforming the health care system. You can download PDF versions of the fact sheets, as well as Word versions you can alter and personalize for your own use.

  • Overview of the fact sheets (PDF) (Microsoft Word)
  • Measuring and reporting on the quality and costs of care to create a transparent health care system (PDF) (Microsoft Word)
  • Providing tools that help consumers make good health care decisions (PDF) (Microsoft Word)
  • Rewarding providers who deliver better care (PDF) (Microsoft Word)
  • Encouraging the rapid adoption of health information technology (PDF) (Microsoft Word)
  • Creating a health care system that delivers the right care at the right time in the right setting (PDF) (Microsoft Word)
  • Ensuring our health care system provides high quality care for everyone (PDF) (Microsoft Word)

Download All Fact Sheets (PDF)

 

August 31, 2007
Comments on Medicare's 2008 Physician Payment Policies
Thirty-one consumer, labor, and purchaser organizations affirmed Medicare's Physician Quality Reporting Initiative (PQRI) as one part of wide-ranging efforts needed to reform how providers are paid and held accountable and provides comments on strengthening the program.

 

June 12, 2007
Comments on Medicare's 2008 Hospital Reporting and Payment Policies
Twenty-four consumer, labor, and purchaser organizations support Medicare's efforts to ensure that hospitals are financially penalized for providing poor quality care and urge CMS to rapidly incorporate additional performance measures for public reporting.

 

April 19, 2007
Consumer, Labor and Purchaser Comment on Medicare's Hospital Value-Based Purchasing Plan
Current Medicare payment policies reward the delivery of quantity, not quality, of care. Value-based purchasing, which links payment more directly to performance, is a key strategy that CMS is adopting in order to evolve from being a passive payer to an active purchaser of care. More than 20 consumer, labor and purchaser organizations provided extensive feedback on Medicare's Hospital VBP Program.

 

January 24, 2007
Plan to Implement Medicare Hospital Value-Based Purchasing
Centers for Medicare & Medicaid Services

 

October 10, 2006
Hospital Inpatient and Outpatient Payment Changes
Centers for Medicare & Medicaid Services

 

August 21, 2006
Comments on Medicare Physician Payment
Centers for Medicare & Medicaid Services

 

July 26, 2006
Provider Payments: How They Work, Implications for Cost & Quality
Resources & Background Material
Provider Payments: How They Work, Implications for Cost & Quality, and Creating a Consumer/Purchaser Policy Agenda
Resources & Background Material, August 2006
The Widening Primary Care and Specialty Income Gap
Presentation by Dr. Tom Bodenheimer, University of California, San Francisco
Supporting Health Care Re-engineering
Pacific Business Group on Health
The "Basics" - Medicare Physician and Hospital Payments
Peter Lee, Consumer-Purchaser Alliance
Physician Payment by Private Sector Health Plans
Michael Ile, United Health Care
Structuring Hospital and Physician Payment: Policy Options
Paul Ginsburg, PhD, Center for Studying Health System Change

 

May 25, 2006
Cost & Price Transparency
Resources & Background Material
Cost & Price Transparency: Presenting Health Care Costs to Consumers
Resources & Background Material, May 2006
Understanding the Issues
Peter Lee, Consumer-Purchaser Alliance
Prescription Drug Pricing
Steve Findlay, Consumers Union

 

June 30, 2005
Principles for Making Medicare Payments Performance-Sensitive
A broad cross-section of consumer and employer organizations - representing more than 100 million Americans - have called for Medicare to publicly report and pay physicians, hospitals, health plans, and other providers on how well they deliver high-quality, efficient, and patient-centered care.
Press release, principles, and endorsing organizations

 

May 2004
State Experience in Health Quality Data Collection
Today, statewide health care data collection efforts exist in 48 states and the District of Columbia. The structure, function, and governance of these organizations varies markedly from one to another. Spurred by the work of the Institute of Medicine, national attention to the issue of medical care quality and the need for data to measure it has greatly increased. This paper documents the richness of the diversity of the state experience and includes some observations on the elements that have proved critical, at the state level, to ensure the data system enjoys continued support.
Full Document

 

July 2003
More Efficient Physicians: A Path to Significant Savings in Health Care
CP Alliance advocates for making information across all of the Institute of Medicine's six domains of health care quality - safe, timely, effective, efficient, equitable, and patient-centered - available and actionable. One of those domains that has received strikingly little attention, given the cost pressures being felt by purchasers and consumers, is the relative efficiency with which care is delivered. To help inform the discussion about Medicare reform and private sector efforts to reward more efficient physicians, the Disclosure Project sought out the opinions of leading actuaries and health researchers to estimate the potential savings to Medicare if either a small portion of beneficiaries began using more efficient physicians or a similarly small proportion of physicians improved the efficiency of their practice pattern. The conclusion: Medicare and other purchasers could save from 2% to 4% of total costs if only one out of ten beneficiaries were to move from less efficient to more efficient physicians.
Brief Summary
Full Document