HHS Value-Driven Healthcare
Transparency: Better Care Lower Costs

Four Cornerstones
The Executive Order is intended to ensure that health care programs administered or sponsored by the federal government build on collaborative efforts to promote four cornerstones for health care improvement.  The Patient-Centered Medical Home has defined characteristics that are aligned with each of the four cornerstones identified in the Executive Office:

1. Interoperable Health Information Technology: Interoperable health information technology has the potential to create greater efficiency in health care delivery.  Significant progress has been made to develop standards that enable health information systems to communicate and exchange data quickly and securely to protect patient privacy.  Additional standards must be developed and all health care systems and products should meet these standards as they are acquired or upgraded.  Relevant Excerpt from Joint Principles:

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

• Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication

2. Measure and Publish Quality Information: To make confident decisions about their health care providers and treatment options, consumers need quality of care information.  Similarly, this information is important to providers who are interested in improving the quality of care they deliver.  Quality measurement should be based on measures that are developed through consensus-based processes involving all stakeholders, such as the processes used by the AQA (multi-stakeholder group focused on physician quality measurement) and the Hospital Quality Alliance.

• Measuring Quality
• Physician Services Standards

Relevant Excerpt from Joint Principles:

Quality and safety are hallmarks of the medical home:

• Evidence-based medicine and clinical decision-support tools guide decision making.
• Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
• Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.  NOTE: The PPC states that physicians should produce reports on how they performed against standardized measures and report those to external entities.  These elements are also in the draft PCMH qualification process document we’re working on with NCQA but they account for very few possible points (2 points for collecting data on standardized measures and 1 point for reporting it to external entities).  

3. Measure and Publish Price Information: To make confident decisions about their health care providers and treatment options, consumers also need price information.  Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers.  In addition, strategies are being developed to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases.

• Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.

[Although not explicitly referenced in the joint principles, the American Academy of Family Physicians and American College of Physicians have jointly proposed a payment framework for the PCMH that includes a bundled and prospective (monthly) payment for care coordination services provided that fall outside of a face-to-face encounter.  Prospective payments for care coordination are more predictable and transparent to consumers and purchasers than procedure-based payments that are billed retroactively following a patient encounter.  PCMHs would also report on evidence-based quality and efficiency or cost of care measures as they become available through a consensus process].

4. Promote Quality and Efficiency of Care: All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-priced health care.  Such arrangements may include implementation of pay-for-performance methods of reimbursement for providers or the offering of consumer-directed health plan products, such as account-based plans for enrollees in employer-sponsored

Relevant Excerpt from Joint Principles:

Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.

Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home.  The payment structure should be based on the following framework:

• It should allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
• It should allow for additional payments for achieving measurable and continuous quality improvements.