California Health Care Improvement Projects (CHIPs) are designed by CHCF Health Care Leadership Program participants with the goal of addressing meaningful challenges or opportunities in health care.
Healthcare prices are hard to understand and navigate for patients and healthcare teams. Health care affordability (out-of-pocket patient costs) is a leading health care concern for Americans and a key voting issue. More than half of Americans worry about the availability and affordability of health care, and more than a quarter have delayed care because of high costs. I am passionate about this work after having a friend lose her life savings due to healthcare costs and my own family has faced large medical bills without guidance to navigate our healthcare system.
As a nation and in California, we have missed the target to reduce out-of-pocket costs to patients, likely because there has been no clear roadmap of how to approach solutions, and key partners have traditionally worked in silos. 70% of patients across the country and 66% of patients in California hold employer-based, non-group, or Medicare insurance coverage. Thus far, among these insurance types, efforts to increase healthcare value have remained focused on reducing the total costs of care with payers and health systems benefiting, with little attention to rising out-of-pocket costs with nearly no accountability or protections for patients.
So I brought together patients, navigators, social workers, care teams, health system leaders, payers from across the country to develop solutions through an Affordability Accelerator. My CHIP aimed to create a roadmap to provide a path to reach these goals from a perspective of building infrastructure to support health system interventions. My team acknowledged that other payer reforms and patient protection legislation will be required to create large improvements. While the new No Surprises Act and Inflation Reduction Act take important steps toward Medicare price caps, price transparency, and balance billing for out-of-network care, efforts to improve affordability must be guided by care teams and supported by health systems to achieve consequential change. Participants identified strategies to better understand and align clinical and financial decisions throughout a patient’s experience prior to, during, and after care is rendered to develop new care pathways. The participants identified key financial friction points for patients and nine key improvement opportunities.