Statement of Susan Sherry, Deputy Director, Community Catalyst, on the U.S. Department of Health and Human Services’ announcement today that it has set a timeline and goals for tying Medicare reimbursements to quality through alternative payment methods.

BOSTON – “The Department of Health and Human Services today announced an important new payment reform initiative that would reward Medicare doctors for value and outcomes rather than volume, or reimbursements for each service rendered. This is a positive step in the right direction, and we applaud HHS for putting forward an agenda that emphasizes the need to improve quality and health while also reducing costs.

“Our current payment structure is broken. We pay twice as much per capita on care than any western democracy. Providers are rewarded for each office visit, test and procedure they provide, which leads to inefficient, ineffective care of variable quality. As a result, we aren’t getting enough ‘bang for our buck.’ Changing the way Medicare and other insurers pay doctors and hospitals could help keep people out of emergency rooms, hospital beds and nursing homes. It could also promote better outcomes while lowering the cost of care.                      

“At the same time, this shift to pay-for-outcomes isn’t a risk-free endeavor. Payments tied to outcomes can induce providers to avoid harder to treat patients, and standardized outcome measures may not promote the best care for patients who may have very different health needs and goals.

“We believe these risks can be overcome with the right approach, which we outline in our recently released paper, “The Path to a People-Centered Health System.” First, it’s critical that the people the health system serves – consumers – be at the table with other stakeholders and have input into the design of these new systems. Second, we need to ensure we design payment incentives so they are fair to health systems that treat poorer and sicker patients. Third, we need robust quality measures that are understandable to patients, not just experts. Finally, we need to help patients navigate the system better to help them get the care they need and hold the system accountable. Our goal is to reward better care and reduce health disparities. For consumers, this needs to be about using our dollars more wisely, not about paying less and getting less. The measure of our success must be better care, not just cheaper care. 

“We are excited about the creation of the health care payment learning and action network. State and local consumer advocate partners will serve as an important feedback loop to federal policymakers about what is working and what needs to be improved, and we are eager to work with our advocacy partners and HHS on these efforts.”


About Community Catalyst

Community Catalyst is a national non-profit consumer advocacy organization dedicated to quality affordable health care for all. Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone – especially vulnerable members of society. For more information, visit Read or comment on our blog at Follow us on Twitter @healthpolicyhub.