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Mark Brager
(202) 434-7244
December 19, 2017

New Report Outlines Gaps in Payment Model Quality Measures

Innovation and Patient Care at Risk 

WASHINGTON, D.C. – Current value-based payment (VBP) models lack adequate quality measures to effectively assess the value of medical technologies, according to a new report released today from Discern Health, sponsored by the Advanced Medical Technology Association (AdvaMed). 

The white paper – “Medical Technology in the Value-Based Environment:  An Assessment of Quality Measure Gaps” – identified “significant gaps” in each of eight clinical areas studied where medical devices are indicated to treat those conditions. 

In each clinical area – ranging from diabetes to wound care to heart failure – the report found “areas where [quality] measures are not being used effectively or are absent from payment models.” Furthermore, those measures that are being used do not “adequately account for the benefits of medical technology” over time or consider patient quality-of-life improvements. 

The absence of effective quality measures in VBP models raises the risk that patients will not have access to the latest medical technologies that may be costlier but provide more effective, and even safer, care. Longer term innovation could be stifled as VBP models discourage the adoption of newer treatment options. 

“Value-based payment can help providers increase efficiency while improving patient care, but only when quality and value are properly assessed,” said Scott Whitaker, AdvaMed president and CEO. “This study underscores the uneven playing field on which medical technology is judged, potentially depriving American patients of the innovative care they deserve.” 

The report outlines a number of steps that should be taken by stakeholders – payers, providers, patients, manufacturers and others – to fill the quality measure gaps for medical technology. For example, payers and policymakers should better leverage real-world evidence on the benefits of medical technology when designing VBP models. Further, VBP models should be designed to recognize the value that innovative technologies provide beyond a time-limited performance year or episode of care. 

“An important takeaway from our findings is that VBP models do not adequately account for patient preference in selecting and using medical technology,” noted Discern Health Partner Tom Valuck, MD, JD. “We need stronger patient-reported measures that assess whether effective, shared decision-making is happening, and whether treatment is improving the outcomes that patients care about.”