Our vision for Better Care is based on continuous improvement of care, removal of inequities, integrated team-based primary and specialty care, patient access to personal health records, and competition among provider and health plans based on quality measured by outcomes.  The Better Care Plan requires fundamental changes to the way we organize and deliver care, the way we pay for care, and the way we measure and report on patient safety and outcomes. This will require specific actions on the part of many stakeholders. The resulting Better Care Plan (BCP) as described in detail this report is organized around three complementary, synergistic initiatives:

1.     Continuously improving, patient-centered, primary care teams

For patients, the BCP is integrated, patient-centered team-based healthcare that addresses their needs and preferences and engages patients in their care. Physicians are motivated to provide preventive care, keep chronic illnesses in control, and understand and address a patient’s issues – from food insecurity to transportation and living conditions – that impact health. Continuous quality improvement (CQI) component of the BCP.

2.     Risk-adjusted, prospectively established budgets

The BCP offers clear and consistent incentives through risk adjusted prospective payment from the health plan premiums collected to the provider organizations to achieve continuously improving evidence-based team care across all public and private payers. Payment is risk adjusted for severity of illness and social determinants of health that rewards continuously improving quality, reduces unnecessary utilization of services, slows disease progression, eliminates inequities, improves health, and slows the growth of healthcare costs.

3.     Collection, analysis and reporting on patient safety and medical outcomes

The BCP requires full transparency regarding health outcomes and patient safety – a significant benefit to consumers and purchasers. A national repository will establish measures and standards for patient safety and outcomes, determine how the data will be collected, analyzed and make the data accessible and understandable to consumers to assist them in choosing plans and providers.  

The core ideas underlying the BCP are neither new nor untested. They can be found in many of the best HMOs, ACOs, and Medicare Advantage plans across the country.  

Four key recommendations for implementing the Better Care Plan include:

1. Make patient safety providers’ number one priority using a system of data driven continuous quality improvement (CQI) to achieve perfect the best possible safety and quality goals. Just 12% of hospitals currently have this type of rigorous improvement system.[i].
2. Establish a Better Care Certification Process to distinguish health plans and associated provider organization networks that meet the Better Care Plan principles and the patient-centered primary care team -based criteria. 
3. Align financial incentives with the BCP principles and criteria, we encourage CMS, health plans and employers to more aggressively accelerate the movement to risk-adjusted prospective payment as the norm replacing the current FFS system.
4. Encourage Congress to direct HHS to designate an entity to create a National Outcomes Reporting Data Base and establish an entity to serve as a National Patient Safety Data Repository that are consistent with the BCP principles and criteria,

Additional recommendations for stakeholders to consider can largely be implemented through individual initiatives with little additional investment, new legislation or regulations. But we recommend ongoing evaluation to assess the extent to which Better Care organizations are successfully continuing to improve care and eliminate patient care inequities.