ACP: revamp health care payments to improve equity, reduce outcome disparities


Internists group advocates greater use of prospective payment models, less reliance on fee-for-service in primary care

The American College of Physicians (ACP) wants to prioritize the needs of underserved patient populations and reduce disparities in health outcomes by overhauling how the U.S. pays for and delivers primary care.

In a position paper published Monday in Annals of Internal Medicine the ACP outlines six policy recommendations designed to provide more care access to underserved populations, increase focus on care value, and achieve greater equity in health outcomes.

Underlying many of the recommendations is a call for greater use of population-based prospective payment models, including hybrid models combining fee-for-service (FFS) and prospective payments. Such models, the paper says, “not only have the potential to achieve high-value care but can also be designed in a way to adjust for the social drivers that impact health outcomes.”

CMS currently ties 90% of its payments to value and 40% through some form of alternative payment model, according to the paper. Nevertheless, “FFS remains an underlying component of most physicians’ compensation, even with the greater adoption of such models.”

The ACP’s recommendations are:

  • Medicare and other payers should adopt population-based, prospective payment models for primary and comprehensive care that are structured and sufficient to ensure access to needed care and address the needs of individuals experiencing health care disparities and inequities based on personal characteristics and/or are disproportionately affected by social drivers of health. Hybrid models combining FFS with prospective payment should be made available and should prioritize the needs of such individuals.
  • Conduct research in creating a validated way to measure the costs of caring for patients who are experiencing health care disparities based on persona characteristics and/or disproportionately affected by social drivers of health. All performance and cost measures used in value-based payment programs must be adequately adjusted for risk, health status and social drivers of health.
  • Establish a mechanism for in Medicare for calculating savings across all aspects of the program, such as savings from reduced emergency department visits and hospitalizations covered by Part A that result from increased investment in relative and absolute payments for primary and preventive health care services covered by Part B.
  • Authorize the secretary of the U.S. Department of Health and Human Services to address inadequacies in the Quality Payment Program, including developing policies and financial approaches to ensure that the program begins to address issues of inequity, health care disparities and social drivers of health.
  • Develop delivery and payment systems that support physicians and other clinicians in offering all patients the ability to receive care where and when they need it and in the most appropriate manner possible, whether in-person or via telehealth, audio only, or other means. Implementing more robust remote care options and delivery and payment methods should not add any unnecessary or overly burdensome administrative tasks or inappropriately question the judgment of physicians or other clinicians.
  • Make adequate funding available to support development of effective health information technology systems and communication methods, including adequate broadband availability, to ensure that delivery and payment reforms can address the needs of all patient populations.
  • Federal and state policymakers, payers, health plans, health systems, investors and philanthropic institutions need to develop and implement additional financing mechanisms, such as grants and technical assistance, to support innovative approaches to addressing inequities, health care disparities and social drivers of health.

With 161,000 members, the ACP represents internists, internal medicine subspecialists, medical students, residents, and fellows.

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