Question

How is PFCC incorporated in policies? What are key components that the policy needs to include and outline?

Answer 1

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care by placing an emphasis on collaborating with people of all ages, at all levels of care, and in all health care settings. In patient- and family-centered care, patients and families define their “family” and determine how they will participate in care and decision-making. A key goal is to promote the health and well-being of individuals and families and to maintain their control.

This perspective is based on the recognition that patients and families are essential allies for quality and safety—not only in direct care interactions, but also in quality improvement, safety initiatives, education of health professionals, research, facility design, and policy development.

Patient- and family-centered care leads to better health outcomes, improved patient and family experience of care, better clinician and staff satisfaction, and wiser allocation of resources.

Core Concepts of Patient- and Family-Centered Care

• Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.
• Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making.
• Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
• Collaboration. Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation; in research; in facility design; and in professional education, as well as in the delivery of care.

Policy option 1.   

1

Giving organizations that contract through Medi-

care’s Shared Savings Program the opportunity to

use the PFCC M/P as their patient-centeredness com-

ponent. Section 1899(b)(2)(H)28 of the ACA requires

an ACO to “demonstrate to the Secretary that it meets

patient-centeredness criteria specified by the Secre-

tary, such as the use of patient can caregiver assess-

ments or the use of individualized care plans.” The

proposed rule suggests that ACOs engage in 1 or more

of the outlined patient-centeredness principles; for

example, improving transitions of care, assessing the

beneficiary experience of care, patient involvement

in ACO governance, or assessing family experience

of care and identification of potential areas of im-

provement.

a

principle that best suits their needs. The proposed

rule gives discretion to the Secretary as the purpose of

the principles is to offer guidance. Numerous patient-

centeredness principles contain elements that are al-

ready incorporated in the PFCC M/P, such as evalu-

ating the patient and caregiver/family experience of

care, improving transitions of care among providers,

and improving communication between providers

and beneficiaries. Other outlined principles are ab-

stract. We propose to include the adoption of the

PFCC M/P as one of the patient-centeredness princi-

ples outlined in the Final Rule.

Policy option 2

Offering organizations that function under the ac-

countable care umbrella and that utilize the PFCC

M/P an additional 10% of shared savings. Section

1899(d)(1)28 of the ACA provides that the ACO shall

be eligible to receive shared savings payments for

each year under contract, given that it meets the es-

tablished quality and performance standards. The

current level of shared savings (>2%) is 60% un-

der the 2-sided contract and 50% under the 1-sided

contract. We propose that CMS offer an additional

10% of shared savings for organizations that have

adopted the PFCC M/P into their practice and have

documented the use of all steps incorporated in the

PFCC M/P during the contract year. Under this pro-

posal, the maximum level of shared savings for a

2-sided contract would be 66% and 55% under a

1-sided contract.

Policy option 3

Using the PFCC M/P as an additional tool to mea-

sure and assess the accountable care organization’s

performance. Because it is necessary to undertake

evaluation of the performance of accountable care

participants, we can refer to the existing PFCC M/P at

UPMC to do the assessment. The PFCC M/P focuses

on using tools to gather information about the way

patients and families actually experience their care

during every crucial “touch point.” In addition to

Shadowing and Care Experience Flow Mapping, the

tools of the PFCC M/P include patient and family.