Our Moment to Right the Ship: CMS Signal to the Sector on Patients’ Basic Needs

Year after year, coalitions of healthcare stakeholders – from providers to payers to elected leaders – have worked to shift incentives in healthcare towards delivering value, rather than volume. And while we’ve seen noteworthy progress toward this goal, we remain in desperate need of improvements to health outcomes and costs. It is clear that more significant change is needed – not just the realignment of financial incentives within existing systems focused on managing disease, but an overall shift in approach towards a broader notion of health.

I can understand (and relate to!) how that statement might generate a bit of an eye-roll. You’d be hard-pressed to attend a conference or read a reform-minded article over the past decade and not encounter well-intentioned sentiments like “we need to put patient health at the center”. But we find ourselves in a moment when it is arguably more important than ever to critically evaluate what realizing our shared goal of achieving patient health would look like – and require.

This is a moment when the future of American healthcare is up for debate, and much of the discussion is focused on things like the stability of individual insurance markets and the structure of subsidies. To be sure,these are important issues that could impact the health of millions of people. But if the discussion begins and ends there, we run the risk of continuing to tinker around the edges of a ship that may have been aimed ten degrees in the wrong direction in the first place.

That’s why it’s so encouraging to see market forces increasingly driving the healthcare sector toward strategies that focus on patients’ basic resource needs. The shift to addressing the most significant drivers of health is playing out as we speak. And in a few short months, the Centers for Medicare & Medicaid Services (CMS), which accounts for nearly $1 trillion in annual healthcare spending, will have kicked off its Accountable Health Communities (AHC) and Comprehensive Primary Care Plus (CPC+) pilots – a major step in righting the ship.

For the first time, CMS, which has a statutory mandate to pay “only” for healthcare, is funding the integration of patients’ basic resource needs into clinical workflows. A host of AHC pilot organizations will test whether identifying and addressing these core needs will reduce total healthcare costs and utilization. At the same time,an unprecedented initiative to improve American primary care will launch in the form of CPC+. The program will drive thousands of primary care practices to screen for basic needs and maintain resource directories to help address those challenges.

These pilots represent significant opportunities for the sector. Successful demonstration of a reduction in healthcare costs and utilization will compel CMS to integrate patients’ basic resource needs into future payment models. Just as importantly, they serve as a powerful market signal, prompting adoption of similar interventions beyond just the pilots themselves. One can look to Accountable Care Organization (ACO) models as an interesting case study here: as CMS incentivized a more coordinated approach to care delivery, the private sector quickly jumped on the market signal. Private payers and providers soon began crafting their own arrangements, and by the time the initial CMS pilots ended (and despite some mixed results), the market was flooded with hundreds of ACOs.

Federal pilots aren’t the only place we’re seeing momentum on integration of basic resource needs into care delivery. From Hawaii to South Carolina to Massachusetts, a growing list of states are focusing on patients’ basic resource needs as a critical lever to improve population health and reign in government healthcare spending.And as more states move to models in which private managed care or provider-led organizations assume financial risk for Medicaid patient care, we will likely see an uptick in initiatives focused on related basic resource needs. This trend will no doubt continue as states face increasing uncertainty and financial strain surrounding their Medicaid programs.

These developments all reflect a growing awareness that we cannot achieve health – the sector’s primary charge – without addressing the basic resource needs that so critically drive it. But this is nonetheless a fragile moment. We risk derailing the growing momentum if new efforts to address basic resource needs fail to deliver results for patients, providers and payers. It is critical that these programs access and leverage the best practices and tools available in the market – from workflows to technology platforms – to position them for success.

With informed strategies and refined tools, the sector can seize this opportunity to focus on challenges that are so critical to overall health. This is our moment to ‘right the ship’ and deliver the care our patients and communities deserve.

Jeremy Schifberg is a senior advisor at Health Leads, where he works with the organization’s clinical, foundation and industry partners to make addressing patients’ social needs a standard of care system-wide – along with overall CMS strategy. Schifberg previously worked in the healthcare practice at global strategy consulting firm Oliver Wyman, where he helped leading health systems and physician groups develop value-based care transformation strategies and improve clinical model design.