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Patient-First Care
(a.k.a. Value-Based Care)
Patient-First Care
Since 2019, USofCare has conducted an extensive deep listening effort to fully understand people’s health care needs and desires. This work taught us that people want affordable, higher-quality care. They also want more time with their doctors, better communication between providers, more personalized and customized care, and to be treated as a whole person rather than a series of symptoms.
Most of the current health care system, incentivizes providers to prioritize the quantity of visits and treatments completed on a patient over the quality of those visits, known as fee-for-service. Patient-First Care, also known as “Value-Based Care,” prioritizes personalized, high-quality, coordinated health care, focusing on the needs of the individual person with the goal of enhancing both the experience and health outcomes for the patient.
USofCare is proud to share resources based on our listening work and research that put quality and people at the center of health care through patient-first care.
To learn more about our work in patient-first care:
Policy Principles:
USofCare encourages interested policymakers and stakeholders to apply these principles to policy proposals to assess whether proposed models and/or legislation live up to the promise of patient-first care.
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Blog
The People Demand It. Experts Agree. It’s Time to Deliver Patient-First Care.
By Lisa Hunter, Senior Director for Policy & External Affairs
“When you think about fragmented, especially when you’re not under one roof… you talk to one doctor, they talk about one thing, you go to a different doctor, totally different symptoms, they’re prescribing medicine that don’t even work together and one medicine makes you sick because you took the other. So that is what is fragmented and complicated, nobody talking to each other, nobody getting their records, you’re responsible for carrying your records around. It’s not a good look.” ~ Focus group participant
Lack of coordination. Cost. Fragmentation. “Sick care” over “health care”. Exhaustion. Frustration. We consistently hear from patients that they are losing faith in our health care system, and it’s easy to understand why. They are fed up with paying more with no expectation of improved health outcomes and being treated as a series of symptoms rather than people. A growing body of evidence supports what people across demographic identities and political ideologies have told us through our extensive listening work. They want a system that delivers patient-first care (what some refer to as “value-based care”), which prioritizes quality over quantity and puts their needs first.
Based on feedback from diverse patients, policy experts, and stakeholders, we’ve developed principles to guide policy reforms that deliver patient-first care. We know from demonstrations in states from Arkansas to Oregon that adopting patient-first care models improves health outcomes while reducing health costs. As people increasingly struggle with the cost of care and worry that our system is headed in the wrong direction, policymakers must take urgent action to deliver the health reforms they demand.
Click here for our Policy Principles to Achieve Patient-First Care
Principle 1: Partner with people to incorporate their needs
All of our policy priorities are developed in response to what we learn from our listening work. It’s crucial that reforms center the concerns of people who experience the impacts of health policies in their daily lives, and that we communicate about solutions in a language people understand. People want to be informed and involved in decisions about their care, and they have better health outcomes when they are able to do so.
Better communication would make me trust my doctor more. I would talk to him more frequently and make sure that he’s listening to me, and that I’m listening to him. I would make sure that we’re communicating effectively. I’ve had experiences with doctors where we didn’t get along with one another and it was not enjoyable. There is no way I’m not going to stay with that doctor; I don’t trust them. It doesn’t make sense. If I don’t trust the doctor, I’m not staying with them.
~ Focus group participant
Bright Spots
The Centers for Medicare & Medicaid Services (CMS) has taken important steps to begin incorporating the needs of beneficiaries into the design and delivery of patient-first care models. The CMS Innovation Center (CMMI)’s 2021 strategic refresh includes “Partner to Achieve System Transformation” as a core strategic objective. On this strategic aim, the Patient-First Care Principles and CMS are aligned. And in practice, CMMI has touted the intensive stakeholder engagement it pursued in the development of the Guiding an Improved Dementia Experience (GUIDE) model, as well as emphasized incorporating community and patient experience in model design within the Stated Advancing All-Payer Health Equity Approaches and Development (AHEAD) model.
Principle 2: Realign financial incentives to improve health outcomes
People want a system that rewards health providers for actually improving their health. Rather than paying for care based on the number of visits, tests, and procedures, a patient-first care approach allows people to spend more time with their providers so they address their full set of unique concerns in fewer visits.
I’m thinking that if you get into the performance part of it …somebody come in and they got issues instead of prescribing them medicine they’ll say hey ‘Can you go to a gym? Can you take this? Let’s look at your diet… maybe you eat too much of this, try this, try that’. Instead of being so quick to give out pills… That is what I really think it’s about, really take the time to know you versus insurance, ‘if I do this extra procedure, I’ll get paid for it.’
~ Focus group participant
Bright Spots
Payment models that reward quality over quantity have improved health outcomes while reducing costs. An example where financial incentives resulted in success is Vermont’s All Payor ACO Model which delivered notable savings (net reduction in state spending by 9.7%) in its first evaluation period, while reducing acute care stays and increasing access to primary care for Medicare beneficiaries. Our hope is to continue seeing these kinds of results as policymakers consider new policies and incentive structures to accelerate the movement toward patient-first care that can help even more peoples.
Principle 3: Deliver whole-person care
Everyone deserves to be treated as a whole person rather than a series of symptoms. Patient-first care means people have access to affordable health care that has demonstrated impacts on health outcomes, especially primary care, and providers coordinate to comprehensively address their needs. It also means that every patient receives high-quality care regardless of their race, income, or where they live.
I didn’t have much trust in my original doctor because I felt invisible. I was looked at as a number. It was really sad, people were scared at the time, things seemed like they were always moving so fast. I felt like I was rushed at my appointments. Honestly, this was my first birth in a different state. My previous healthcare providers were back in New York. I changed providers and it was awesome. My doctor was and is excellent. I love him. I have an appointment with him this coming week! He’s professional, thorough, kind, explains everything, and had me totally at ease. Just an awesome man!
~ Focus group participant
Bright Spots
Primary care often serves as the foundation of a patient’s relationship with the health care system. When people have access to a usual source of care, they are more likely to receive high-quality health services. Similarly, when states orient resources to prioritize primary care, people have better health outcomes. More action is needed to invest in and reward the comprehensive, equitable care that improves people’s health, and CMMI has made some progress in recent models announced that expressly address whole patient care. In fact, the Transforming Maternal Health model makes “whole person care delivery” a central pillar of the demonstration, acknowledging how the pregnancy and birthing experiences are intimate and allowing for the provider-patient experience to address physical, social, and mental health needs not traditionally afforded in the maternal health journey.
Principle 4: Promote Accountability to Patients
Patient-first care models should adopt a core set of patient-reported quality measures across payers and populations to fully capture the patient’s perspective. The data collected from these metrics should be used to determine whether providers are achieving patient quality and health equity goals.
The system must get away from money and instill one that focuses on outcomes. There is no accountability. Doctors can get away with whatever they want, as long as they think it benefits the patient. It’s very risky.
~ Focus group participant
Bright Spots
CMMI’s strategic objective to “Partner to Achieve System Transformation” includes a stipulation that all new models “collect and integrate patient perspectives across the life cycle.” CMS has begun testing and incorporating patient-reported measures of outcomes and experience in their models, with implementation of this strategy ongoing. For example, CMMI encourages beneficiary experience and patient-reported outcomes measurement in recent voluntary models such as within the AHEAD model, as well as within mandatory models such as the Comprehensive Care for Joint Replacement model, offering some flexibility for providers to become familiar with reporting on more comprehensive patient experience measures.
People Demand Better
There are many barriers in getting people the right care they need; whether it’s a stigma, whether it costs too much money, or several other [possible] reasons.
~ Focus group participant
Diverse patients across demographics, political affiliation, geography, and more, as well as health care experts agree that our health system should focus on improving people’s experiences and outcomes rather than offering more units of fragmented, expensive, and poor quality care. In its recent strategy refresh, the CMS Innovation Center stated its goal to ensure that the majority of Medicare and Medicaid beneficiaries will be in a patient-first care relationship by 2030. This is a commendable goal, but ensuring it becomes reality will require continued dedication at all levels of government. We urge policymakers to use our patient-first care policy principles to deliver the care people demand.
More Resources
Ready for more resources on Patient-First Care? Click here!
Fact Sheet
This fact sheet shows how our research findings inform our overall messaging on payment models that prioritize quality over quantity.
Shifting the Health Care Approach: Quality over Quantity
This is an in-depth look at the history behind USofCare’s work and the public opinion research that informs our work. Take a look at the topline takeaways, messaging strategy, terms to watch, and more.
Talking About Patient-First Care
Don’t know where to begin to talk about Patient-First Care? Check out our recommendations for how to talk about what it is and its impact on patients with policymakers, health care experts, and more.
Overview of Our Research
This quick 2-pager introduces why we started this research and why it is significant in the health care and health care policy landscape.
Moving Towards a Patient-First Care Payment Model
On March 6, 2024, United States of Care held What State Advocates Should Know: CMS’ New AHEAD Model, a webinar that highlighted considerations for states moving to patient-first care payment models, with a specific focus on the Center for Medicare and Medicaid Innovation’s new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.
Speakers from the CMS Innovation Center and Vermont’s Agency of Human Services joined United States of Care staff to provide state advocates with an overview of the AHEAD Model’s goals and components, dive into considerations and benefits for states interested in pursuing the model, and highlight opportunities for state advocates to encourage their states to prepare and apply.