How to Improve Consumer Health Care Choices, Empower Patients?

AAFP Offers CMS Solid Solutions

July 21, 2017 11:59 am News Staff

The AAFP rarely passes up a chance to offer comments and suggestions regarding federal health care policy. And so it's no surprise that the Academy replied succinctly to questions related to four specific policy goals cited by HHS in a solicitation for comments published in the June 12 Federal Register(www.gpo.gov).  

[Arrows shot into burlap bag tagged with word Bureaucracy]

The July 12 letter(2 page PDF) to CMS Administrator Seema Verma, M.P.H., was signed by AAFP Board Chair Wanda Filer, M.D., M.B.A., of York, Pa.

The request is part of an ongoing effort to to comply with an executive order(www.whitehouse.gov) issued by President Donald Trump on Jan. 30 that addresses reducing regulation and controlling regulatory costs.

In its letter to the agency, the AAFP answered questions related to burdens created by the Patient Protection and Affordable Care Act with respect to the individual and small-group health insurance markets.

The agency asked for feedback from the public on how to

  • empower patients and promote consumer choice, including helping them choose a health plan that best meets their needs;
  • stabilize the individual, small-group and nontraditional insurance markets to encourage uninsured individuals to buy coverage;
  • affirm the traditional regulatory authority of states regarding the business of health insurance; and
  • enhance affordability of coverage for individual consumers and small businesses .

The last bullet touches on an AAFP priority -- namely, consumers' access to care that they can afford. The AAFP urged CMS to require marketplace plans "to provide benefit design options that incentivize high-value care for prevention and chronic disease management."

The letter repeated the AAFP's oft-stated support for the use of core measures sets developed by the Core Quality Measures Collaborative to "ensure alignment, harmonization and the avoidance of competing quality measures among payers."

And the AAFP stressed the importance of continuing reforms that support the primary care medical home and that drive health system transformation across the board -- including both payers and patient populations.

Regarding consumer empowerment and choice, the AAFP urged CMS to develop consumer assistance tools that would allow users to compare health plan features. In addition, consumers need real-time access to information about provider networks, the quality of health plans and consumer satisfaction rankings, said the AAFP.

Furthermore, CMS must invest more resources in marketing and outreach to young adults looking for coverage and in training people to help consumers choose marketplace plans.

That latter request takes on particular significance in light of recent news reports(www.usnews.com) that state the Trump administration has ended contracts with a number of vendors who had provided sign-up assistance to people in 18 cities and regions throughout the United States.

Regarding stabilization of insurance markets, the AAFP noted its support for "reinsurance and improvement in risk adjustment methodology." Furthermore, the Academy called for

  • a longer open enrollment period,
  • health plan issuance of insurance cards once consumer enrollment is verified and coverage begins,
  • physicians' electronic access to accurate patient eligibility information, and
  • a crackdown on the insurer practice of narrowing networks.

On the topic of states' authority in regulating health insurance, the Academy urged CMS to "create a federal-state partnership on insurance regulation and standards for plans across states to reduce plan and provider administrative burden."