‘Patients must be at the center’ of cost, quality decisions

OPINION:

Increasing quality, improving outcomes, and lowering costs aren’t new concepts. Prior administrations have talked about the need to move towards a more sustainable system, one that pays for value and not merely volume. And some progress has been made — but, if we are going to take the final steps, we must activate the most powerful force in our healthcare system for creating value: the patient.

Patients must be at the center of cost and quality decisions, empowered with the information they need to make the best choices for themselves and their families.

This means that we must be completely transparent when it comes to price and quality, and the patient should be the primary controller of their health records, so that they can take those records to whatever provider can deliver value. Through this empowerment, there will be a competitive advantage for providers that deliver coordinated, quality care, at the best value, to attract patients who are shopping for high quality care.

In March, along with the White House Office of Innovation, we launched the MyHealthEData initiative to empower patients by giving them control of their health records. We made it crystal clear that the days of finding creative ways to trap patient data in closed systems must come to an end. It no longer will be acceptable to limit patient records or to prevent them and their doctors from seeing their complete history.

We have proposed payment consequences for hospitals that don’t give patients access to their health records, and have asked for feedback on making it a requirement that all providers share health records with patients as a condition of participating in Medicare.

With all of this data sharing, however, protecting the privacy of patient information is even more paramount, so we are requiring that hospitals also take every action necessary to protect patient records. We aren’t just telling providers what to do, we are also leading by example. Earlier this year we announced Blue Button 2.0, a developer-friendly, standards based API, which will allow a majority of Medicare beneficiaries to connect their claims data to third party applications, services, and research programs.

This will unleash innovation to create new cures, evidence based treatments, and increase the quality of patient care in ways we can’t even predict. Take a moment and imagine the potential imagine a world in which every treatment your doctor gives you is informed by data from similar patients from all over the world, reducing medical errors and increasing the effectiveness of treating whatever condition you have. Imagine a world in which all of the health data we produce, whether it’s through doctor’s visits, diet, sleep patterns, or the dozens of data points we produce from wearable devices was compiled to not only make us better aware of our health, but to also prevent serious health conditions. These advancements are within our grasp, but the key is empowering the patient.

We are also empowering the patient by working to advance price transparency. In virtually every sector of the economy, you are aware of the cost of services before you purchase them, except for healthcare. Patients deserve, and need to know cost of services, if they are going to be empowered to shop for value. To this end, we are proposing to require that hospitals post their charges online. We know that that won’t fully address patient needs, but we are just getting started and have asked the public for ideas about what additional information patients need to make informed decisions about their care. I look forward to working with many of you on this important initiative.

Times have changed and as our health care costs go up, consumers’ demands have changed. And the expectations of CMS have changed. And I understand that some of our initiatives might require providers to change the way they do business. I know it may not be easy, but we owe it to patients. This isn’t about provider needs, but about patient needs — and sooner or later, that will be each and every one of us.

• These remarks are excerpted from Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma’s May 7, 2018 speech at the American Hospital Association Annual Membership Meeting in Washington, D.C.