ACP Provides 'Bold New Prescription' for Broken Health Care System

In a series of policy papers, the American College of Physicians describes its new vision for the U.S. health care system

Jan. 10, 2020 (ACP) – The American health care system is ill, and the American College of Physicians is offering a bold new prescription designed to put the nation on the road to recovery.

ACP lays out its ambitious new plan in a series of policy papers titled, “Better Is Possible: The American College of Physicians Vision for the U.S. Health Care System.” As a united and interconnected whole, the papers call for systemwide health care reforms.

“ACP is proposing a number of interconnected, comprehensive, and evidence-based policy recommendations that reimagine the nation's health care system as one where everyone has coverage for and access to the care they need at a cost that they and the country can afford,” said Dr. Robert McLean, president of ACP. “Our patients deserve better than the status quo, and we truly believe that better is possible.”

The four policy papers, which appear in a supplement to ACP's journal Annals of Internal Medicine, include an overall call to action and specific plans that address barriers to care/social determinants of health; coverage and cost of care; and health care delivery and payment system reform.

In an editorial accompanying the call-to-action paper, McLean and other ACP leaders outline the American health system's symptoms: “Costs are too high, many people lack affordable coverage, incentives for hospitals and physicians are misaligned with patients' interests, primary care and public health are undervalued, too much is spent on administration at the expense of patient care, and vulnerable individuals face daunting barriers to care.”

ACP's own mission mandates that it stand up for physicians and patients, McLean writes. As a result, the ACP Board of Regents directed its committees and councils in 2018 to develop a vision for a better American health care system. The new policy papers are a result of this effort.

In developing the new papers, ACP gave all U.S.-based members the opportunity to share their views through a survey. More than 1,000 members submitted open-ended recommendations which were considered in the final development of the papers. ACP Leadership and Governance had extended time to comment and share recommendations for review, and feedback to be considered for inclusion in the papers. Every ACP committee was provided with an opportunity to share with the developers of the papers their ideas on how to achieve better health care for all, from their areas of expertise. No other ACP policy paper has been afforded as many opportunities for individual ACP member, committee member, chapter governor, and regent input.

“The U.S. health care system is like a chronically ill patient, and ACP is proposing a new prescription,” McLean writes. “Simple market solutions have been unsuccessful elsewhere, and we do not believe that health care is a commodity. Issues of health are intensely personal, and care is not an item on a store shelf.”

ACP believes it's important to not only describe how to get to a better future, but also define what a better future should look like. To that end, the policy papers offer 10 components of a health care system that is both “better” and “possible”:

1. Everyone has coverage for and access to the care they need at a cost that both they and the nation can afford.
2. Social factors that contribute to poor and inequitable health are addressed. Barriers to care for vulnerable and underserved populations are overcome, and no person is discriminated against based on personal identity characteristics.
3. Payment and delivery systems put patient interests first and support physicians and their care teams in delivering high-value, patient-centered care.
4. Unnecessary administrative spending costs are redirected to funding health care coverage and research, public health and interventions to address social determinants of health.
5. Clinicians and hospitals deliver high-value, evidence-based care within available resources. The public and physicians are involved in determining priorities and allocating funding and resources.
6. Primary care has equitable payment levels between complex cognitive care and procedural care. Payment systems support the value that internal medicine specialists bring to patient care.
7. Financial incentives are aligned to achieve better patient outcomes, reduce costs and reduce inequities in health care.
8. Inefficient administrative and billing tasks are removed, documentation requirements are simplified, payments and charges are more transparent and predictable, and delivery systems are redesigned to make it easier for patients to navigate and receive needed care conveniently and effectively.
9. Value-based payment programs support clinical care team collaboration and use only appropriately attributed, evidence-based and patient-centered measures.
10. Health information technologies enhance the patient-physician relationship, facilitate communication across the care continuum, and support improvements in patient care.

To reach these goals, ACP calls for the following actions in the policy papers:

• Coverage and Cost of Care. Transition to a system that achieves universal coverage with essential benefits and lower administrative costs (and associated administrative paperwork required of physicians and their patients) through two potential approaches: a single-payer financing system or a publicly financed coverage option with regulated private insurance.
  Either way, cost sharing that creates barriers to high-value care should be eliminated. Additionally, payments to physicians and other health professionals, hospitals and others delivering heath care services must be sufficient to ensure access and not perpetuate existing inequities, including the undervaluation of primary and cognitive care.
  The College also proposes controlling costs by lowering excessive prices, increasing adoption of global budgets and an all-payer rate setting, prioritizing spending and resources, increasing investment in primary care, reducing administrative costs, promoting high-value care, and incorporating comparative effectiveness and cost into clinical guidelines and coverage decisions.
• Health Care Delivery and Payment System Reforms. Redesign health care delivery and payment to support physician-led, team-based care delivery models in providing effective, patient- and family-centered care. And increase payments for primary and cognitive care services, redefine the role of performance measures to focus on value to patients, eliminate “check-the-box” reporting, and align payment incentives with better outcomes and lower costs.
  ACP also recommends eliminating unnecessary or inefficient administrative requirements and redesigning health information technology to better meet the needs of clinicians and patients.
• Reducing Barriers to Care and Addressing Social Determinants of Health. Put an end to discrimination and disparities in access and care, resolve workforce shortages including the shortage of primary care physicians, and understand, address and overcome social determinants of health. Efforts should also be increased to address public health threats such as firearm-related injuries and death, environmental hazards, climate change, maternal mortality, substance use disorders and health risks from nicotine, tobacco and electronic nicotine delivery systems.

“The audience for these papers is the public at large, our legislators and policymakers especially, and of course our physician colleagues and other fellow members of the health care community,” McLean said. “We are hoping that these policy papers will encourage important and appropriately detailed health care policy understanding and discussion.”

He added: “There is a great amount of misinformation and disinformation in the area of health care policy, and that is likely to increase greatly in this election year. We must do what we can to advocate for meaningful and accurate discussions around these topics and to not allow our legislators and policymakers to obfuscate with rhetoric.”

More Information

The ACP call-to-action paper “A Better Health Care System for All: The American College of Physicians' Call to Action” is available on the Annals of Internal Medicine website.

• ACP invites all members to join the conversation:
• Engage on social media by using #ACPVision4HealthCare.
• Participate in a Twitter chat (#ACPVision4HealthCareChat) on Tuesday, January 28, 2020, at 8:00 p.m. ET.
• Register to participate in a webinar for ACP members on Wednesday, February 5, 2020, from 3:00 p.m. – 4:00 p.m. ET.
• E-mail your thoughts, questions, and suggestions to us at newvision@acponline.org

Back to the January 24, 2020 issue of ACP Advocate