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APMs, Health Data Exchange among Top Payer Reform Goals

A new report identifies APMs, health data exchange, patient engagement, and community resources as the top four healthcare reform areas.

APMs and Health Data Exchange in Top Payer Reform Goals

Source: Thinkstock

By Thomas Beaton

- The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower overall healthcare costs and improve patient outcomes.

The report outlines four priorities that involve designing value-based reimbursement models, improving caregiver and patient engagement, collaborating with communities to build health resources, and advancing healthcare data accessibility and sharing.

“The United States is poised at a critical juncture in health and healthcare,” the report stated. “Powerful new insights are emerging on the potential of disease and disability, but the translation of that knowledge to action is hampered by debate focused on elements of the Affordable Care Act that, while very important, will have relatively limited impact on the overall health of the population without attention to broader challenges and opportunities.”

“The National Academy of Medicine has identified priorities central to helping the nation achieve better health at lower cost.”

To advance value-based reimbursement, NAM suggested that public and private payers should develop more APMs that hold providers accountable for delivering population-based care.

Healthcare stakeholders, including payers, should also help clinicians develop the core competencies required for APMs and remove barriers that block medical and social services integration.

Another priority action for healthcare reform involved advancing patient engagement initiatives. Researchers pushed for more policies that allow patients and their families to use their own health information to make more informed healthcare decisions.

“To be effective, policy reforms must do more than simply achieve engaged patients—rather, reforms need to ensure that patients and their families are fully informed and able to participate as partners in determining outcomes and values for their own health and healthcare,” NAM wrote.

“Further, empowering individuals to lead their own health care decisions requires giving them ownership of their personal health data,” the organization added.

According to the report, tools to achieve this priority action include increasing patient literacy, harmonizing payer reimbursement standards for telehealth access, and making health data private and accessible.

NAM also identified community collaboration as another major healthcare reform priority area.

“Communities have essential roles to play in combating the nation’s most pressing health threats, such as the chronic disease and substance abuse epidemics,” NAM wrote. “To be successful, community solutions require a supportive policy and resource environment to facilitate community efforts.”

The organization contended that local- and state-level initiatives for community-based care should be bolstered through resources from health insurance payments and other payer programs.

“Strengthen local level infrastructure and capacity for multi-sectoral health initiatives, using resources marshaled from federal grant programs, tax incentives, health insurance payments linked to population health, and public-private partnerships,” the report stated.

NAM also called on stakeholders to focus healthcare reform policies on improving health IT and digital interfaces.

Stakeholders should develop policies that remove clinical data accessibility and use challenges, such as specifications for data developed but not adopted, commercially protective coding practices, and proprietary data ownership and use prohibitions.

The organization also pushed for healthcare reform policies that promote end-to-end interoperability and pinpoint health IT and data strategies that encourage continuous learning and communication across the care continuum.

Through the healthcare reform policy suggestions, NAM intends to help stakeholders better appropriate healthcare funds to initiatives and areas that can reduce healthcare costs.

“Because this trajectory of healthcare spending is unsustainable, reforms are needed that enable health care organizations, communities, and individuals to redirect resources to uses that achieve better health, promote efficiency, and reduce waste,” the organization wrote.

“Furthermore, by fostering incentives and culture change supportive of proven, value-based models of care payment and delivery as well as connected healthcare and information, greater efficiency, better results, and more person-engaged care could be achieved.” 


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