Value-Based Payments Require Valuing What Matters to Patients

Sylvia Burwell, Secretary of Health and Human Services, recently announced the department’s intention to tie most Medicare fee-for-service payments to value by 2018. Most commercial insurers already incentivize quality to some degree and encourage beneficiaries to consider quality and cost. Having payers aim for value should improve health system performance, certainly when compared with traditional incentives for the volume of services, which have failed to deliver the kind of care that is possible.

Paying for value, though, requires measuring what actually matters to patients. Yet almost all current quality metrics reflect professional standards: eg, medications after myocardial infarctions, cancer screening according to guidelines, or glycated hemoglobin A1c levels being under control for patients with diabetes. These metrics are relatively straightforward to calculate with available data, and patients’ interests usually align with professional standards—people want medical services to help them live longer, prevent or cure illnesses, limit the likelihood of and morbidity from disease and injury, and avoid or effectively manage symptoms. Although there are instances when professional standards seem to diverge from what some patients want (ie, when patients request antibiotics for upper respiratory tract infections), in most situations, there is congruence between professional standards and patient needs.