Addressing Affordability – Costs of Care’s Clear Focus

Chris Moriates MD, Executive Director of Costs of Care

Over the past 10 years, Costs of Care has helped lead the value improvement movement through a number of overlapping phases, from raising awareness and advocating for transparency, to addressing appropriateness by supporting clinician-led efforts to reduce waste and low-value care. There is still much work to be done on each of these fronts and as an organization we will continue to be meaningfully engaged in advocacy, awareness, appropriateness, and education. However, while each of these foundational components are necessary, they are insufficient for making the impact we want to see on patients’ financial and physical experience of health care. To truly provide greater value for diverse populations, we must meaningfully address patient affordability.

Even as entire health systems have begun to reduce total costs of care, affordability remains the leading health care concern for Americans. This is because out-of-pocket health care costs are rising at a rate that is even faster than national total costs of care, making health care costs no longer an abstraction but a kitchen table reality for most Americans. Focusing health care efforts on total costs of care for populations while ignoring soaring out-of-pocket costs for individual patients’ risks worsens the affordability crisis. Addressing patient affordability requires new strategies and interventions.

With an article released today in NEJM Catalyst, our Costs of Care team advances the discussion about patient affordability. Reshma Gupta, MD and Jordan Harmon, MHA teamed up with Patrick Conway, MD, President and CEO of Blue Cross Blue Shield of North Carolina, and former Deputy Administrator for Innovation and Quality at the Centers for Medicare and Medicaid Services, to define the “next frontier in reducing costs of care.” They sharply distinguish between total costs of care for populations and the affordability of care for individuals, articulating the need to focus on patient affordability as a meaningful and relevant outcome of health care delivery. Also proposed, is how to do something about it – laying out a framework of key components for health care systems to address patient affordability.

In 2013, our Costs of Care team put forth a framework for integrating the concept of “financial harm” into clinical decision-making, with an article in JAMA called “First, Do No (Financial) Harm.” The article advocated for four general steps that physicians can take to help avoid patient financial harm. I believe the current NEJM Catalyst article “The Next Frontier in Reducing Costs of Care: Patient Affordability” is a new milestone for our group in moving the goalposts once again with a simple pragmatic path forward. Much like our financial harm framework, the key components and approach for addressing affordability will need to evolve and be tested. We know this is not the solution but rather the start of the conversation. Everyone has a stake in health care costs and we look forward to working with our colleagues near and far – patients, physicians, nurses, health care administrators, payers, pharmacists, community caregivers – every one – on chartering a new path to accelerate affordability for our patients.