WASHINGTON – The Quality Payment Program, the value-based payment scheme created under the Medicare Access and CHIP Reauthorization Act, will focus on measuring clinical outcomes – instead of processes – if Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has her way.
“I think the concept of paying for value is a good concept,” Ms. Verma told attendees at the annual meeting of the federal Office of the National Coordinator for Health Information Technology on Dec. 1. “A lot of the measures in terms of how we are evaluating providers aren’t necessarily around outcomes. There are a lot of process measures.”
“Many of us have used the health care system and can attest that it is also a lot of times confusing,” she said. “We don’t know where to go for our care. Who is the best doctor? We don’t always have the information about cost or quality or value, and it is difficult to navigate the health care system.”
She said she wants to “make sure that the data that we have at CMS is available to our beneficiaries, whether it be information about their claims data, information about quality, information about the health plan that they may pick, information about their provider directory, information about the quality ratings if they are seeking hospice care.”
Getting to that point will require addressing an ongoing and familiar problem for physicians: interoperability of health care IT systems.
Improved interoperability would allow for greater patient empowerment by providing patients with better access to their own medical data, she said, noting that the data also belongs to the patient.
“That is our information and the patient should have that,” Ms. Verma said. “When we talk about patient empowerment and patients first, this is what we are talking about. This is what I mean. I want to make sure the beneficiaries who are using the Medicaid program, the Medicare program have this information. That is important.”
She also noted that improved interoperability will allow for greater use of data across the health care spectrum, including in the area of drug pricing.
“We have some very high-cost new drugs coming,” she noted. “We are having discussions about how to pay for these drugs in a different way. Maybe we are going [toward] value-based pricing or indication-based pricing [and] so paying for the drug based on the outcomes.”