Patient Role in Value-Based Care

Every individual has a meaningful role to play in their health care – each person’s voice, concerns and health goals matter. This is especially true in value-based care, which is health care designed to focus on quality, provider performance and the patient experience. The CMS Innovation Center works with health care providers to test different approaches to value-based care.

Value-based care puts people at the center of their care. Doctors and other health care providers partner with individuals to create unique care plans that are personalized to each person’s needs and goals.

How Patients Can Be Active Partners in Their Care

The individual’s voice matters in Innovation Center pilot programs, which are called “models,” and in value-based care. The following are ways that individuals can be more active partners in their health care.

Ask Questions

When individuals receiving care ask questions about something that doesn’t seem clear about their treatment plan or overall health, they help health care providers identify aspects of care that might need to be explained in more detail or additional resources that can be provided.

If an individual learns that their doctor is part of an Innovation Center model or part of another program in Medicare or Medicaid and doesn’t know what it means for them, they might consider asking:

• What can I expect?
• Will it change my care? If so, how?
• Will I have access to any new services? Do I need to do anything to get access? Am I required to use the services? (Note: In most cases, individuals receiving care are under no obligation to use new services offered as part of a pilot program.)
• Who should I contact if I have questions or concerns?
• What is the goal of the model? Why are you participating?

Share Concerns

As partners in their care, individuals can help their health care providers understand how they are experiencing their care – what’s going well and what’s not. They might consider:

• Making a written, prioritized list of their concerns or other items they want to discuss, starting with what’s most urgent or important.

• Identifying any barriers to following through on parts of their care. As part of value-based care, care teams may be able to help individuals address nonmedical issues affecting their health, such as transportation to appointments, access to nutritious foods or their living situation.

• Proactively sharing any updates about their health, for instance whether they’re seeing other providers or taking new medications or supplements or if they’ve experienced a significant life event or change (such as a loss).
   
• Letting their providers know if a concern is not fully addressed. Individuals might ask who to contact if they need to speak with someone between appointments.

Communication Is Key

As part of their participation in an Innovation Center model focused on value-based care, health care providers might set up additional channels for individuals receiving care to stay in touch outside of medical appointments. This includes online portals where individuals can get questions answered any time of day or connecting people with care coordinators to assist with navigating their care and/or setting up appointments.