The COVID-19 pandemic has posed enormous, unparalleled challenges to the U.S. health care system. As hospitals across the country struggle to meet the staggering number of cases, the nation also is reckoning with its history of structural racism and racial disparities in health care and outcomes. The Biden-Harris administration has an opportunity to mount an effective pandemic response and build its health care agenda. With so many interrelated crises looming, it is imperative that the administration develop a plan quickly and prioritize which steps to take immediately and which can be handled in the near future.
The Commonwealth Fund Task Force on Payment and Delivery System Reform’s new recommendations will help federal policymakers seize this moment. Experts from across the health care sector and the political spectrum, the Task Force spent 18 months reviewing the best evidence from the past decade of innovation, synthesizing recent lessons from the COVID-19 pandemic, and harnessing their real-world experience to reach agreement on how to make the health care delivery system work better for everyone. With more than 80 specific recommendations, the resulting report seeks to provide concrete guidance for change.
The Task Force identified six policy imperatives to advance a system of higher-quality, more affordable, and more equitable care.
- Increase the delivery system’s preparedness for health disasters. To ensure the health care delivery system is ready to meet future public health crises, Congress should strengthen surveillance to better track epidemic and nonepidemic illness and their impact. Congress also should empower the U.S. Department of Health and Human Services (HHS) to develop a secure public health information system for rapid and secure exchange of electronic health information.
- Increase accountability for health care quality, equity, and cost. A careful review of innovations and experiments in delivery system reform over the past 10 years yielded insights into what works and what should be discontinued. The Task Force recommends that the Centers for Medicare and Medicaid Services (CMS), building on these lessons, should require all Medicare providers to participate in promising value-based payment arrangements and offer financial and technical assistance for providers that need it. In Medicaid and the Children’s Health Insurance Program, Congress should encourage uptake by allowing a higher federal match rate for states implementing value-based payment approaches.
- Strengthen the nation’s primary health care system. Decades of research show that strong primary care can improve outcomes, lower per capita costs, and increase equity. During a pandemic, a robust primary care system is the critical infrastructure to care for patients and administer and monitor vaccinations. Unfortunately, the U.S. fails to invest properly in primary care, especially for people of color and low-income populations. The Task Force recommends that CMS significantly increase its reliance on capitated or hybrid prepayment models in primary care, work to enhance compensation of primary care clinicians to better attract providers to the field, and further invest in programs to diversify the primary care workforce.
- Support empowerment and engagement of people, family, and communities. Partnerships among health care providers, patients, and communities are essential for improving patient experience, building trust, and ensuring our health system reverses long-standing inequities. HHS and national health care accreditation organizations should require all provider organizations and insurers, in partnership with patients and communities, develop and implement plans to eliminate health disparities and combat structural racism and require organizations to publicly report progress. Also, to allow providers to better engage patients via digital platforms and ensure everyone can access these technologies, Congress should fund the Federal Communications Commission to establish broadband internet service in all communities.
- Reduce administrative burden. The U.S. will not achieve high performance without first addressing the complexities in our health system that contribute to financial waste, patient frustration, and clinician burnout. Congress should direct the Office of the National Coordinator for Health Information Technology and CMS to create a uniform, national billing system for all private and public payers and also direct HHS to establish a smaller and more efficient set of core quality and equity metrics that can be used by all payers and clinicians.
- Encourage a balance of regulatory and competitive approaches to promote a high-performing health system. For any of the recommendations to realize their potential, the United States also must also address the notable failures in health care markets. The Task Force recommends that Congress require the federal government to correct market distortions and control costs in areas where health care competition is absent and states have failed to implement remedies. HHS also should use its authority, and Congress should pass new legislation as necessary, to provide payers and purchasers in local markets with transparent information on price, quality, and utilization.
As we continue to fight the COVID-19 pandemic and piece together our broken health care system, now is the time to articulate a way forward. The Task Force’s recommendations provide a blueprint to help federal policymakers address the pandemic and ensure more equitable, cost-effective, and higher-quality health care for all Americans. Using these recommendations can lead the way for the United States to achieve a health care system that’s better for patients and their loved ones, for health care providers, and for society.