The model seeks to: 

• Address significant racial and socio-economic disparities with kidney transplant recipients. 

• Improve shared decision-making between providers and patients (i.e. giving patients enough information to participate in their transplant care).  

• Restructure payments to ensure that providers are focused on improving patient quality of life. 

• Increase the number of people who receive a kidney transplant, regardless of age, race, ethnicity, and socioeconomic status.  

Families USA strongly supports the work of CMMI to explore and implement promising new mandatory payment models for qualifying hospitals, and we applaud the design of the IOTA model as a mandatory model while also advising on areas of improvement to strengthen model design. Areas of improvement include the following:  

• Improve data collection and metrics on health equity, specifically social driver of health (SDOH) measures at both 365 days- and 3 year- post-transplant.  

• Improve health equity through increased performance-based payments that will direct a portion of the payments into a SDOH fund specifically for patients on a waitlist who may be experiencing financial barriers, such as those who may have difficulty affording post-operative care.  

• Improve shared decision making by requiring hospitals to facilitate conversations between kidney transplant candidates and qualified support personnel such as palliative care providers so that patients understand the unique tradeoffs of kidney transplantation. CMS should further provide participating hospitals with guidance on how to engage in these conversations.  

Models such as IOTA are setting the foundation for a shift toward meaningful, value-based care, all while addressing critical health inequities for patients with ESRD. 

The post Families USA Submits Comments on the Increasing Organ Transplant Access Model appeared first on Families Usa.

These recommendations are aimed at ensuring access to an affordable, equitable, effective and comprehensive primary care system:

• Ensure the Pay PCPs Act gives the Secretary of Health and Human Services (HHS) substantial authority to make regular changes and updates to the design of the hybrid primary care payment model on several areas including:
  • Patient attribution methods to ensure the model utilizes the gold standard of patient attribution.
  • Payment model methodology to account for disparities in access to care and historically low and undervalued reimbursement rates for primary care-related services.
• Prioritize social drivers of health (SDOH) by incorporating social needs and social services data into health care data systems to more accurately account for the health needs and costs of socially vulnerable and marginalized populations.
• Ensure physician fee schedule (PFS) rates, the prices and reimbursements for clinical services, are determined by a variety of non-partisan health care payment experts to combat biased estimates and distorted fees.

The U.S. spends significantly less on primary care than other developed nations, contributing to a national shortage of primary care providers, and providers are currently incentivized and rewarded for higher volumes of services (tests, bloodwork, exams, etc.) without any accountability, oversight, or proof that these services are improving patient health outcomes. In fact, many of the most valuable services provided in primary care, such as home visits or telephone calls, have long gone uncompensated.

Families USA applauds Senators Bill Cassidy, M.D. (R-LA) and Sheldon Whitehouse (D-RI) for the introduction of the Pay PCPs Act which, if passed, would be a significant step toward a sustainable payment mode for primary care providers — with a reimbursement system that directly pays them for what they do best, effectively managing the health of patients.   

The post Families USA Submits Response to Request for Information on New Legislation to Improve Primary Care appeared first on Families Usa.

The post Written Testimony of Sophia Tripoli for Senate Committee on Aging appeared first on Families Usa.

• Achieve meaningful price transparency in health care.
• Establish site neutral pricing to prevent people from paying more for the same care just because it was performed in a hospital setting rather than a doctor’s office.
• Prohibit anti-competitive practices that keep health care prices unfairly high for patients and families.

The post Consumers for Fair Hospital Pricing and Consumers First Letter to Senate Committee On Aging to advance bipartisan policies this year appeared first on Families Usa.

We believe it is critical for the experiences of the millions of people who rely on Medicare to access affordable prescription drugs to remain the focus of implementation efforts. To that end, our comments provided recommendations across the following areas:

1. Section 60.4: The negotiation process;

2. Section 60.3.2: Developing a starting point for the initial offer; and

3. Section 40.4: Providing access to the MFP for 2026 and 2027.

Click the download button below to view the Comment.

The post Families USA Comments to CMS on Medicare Drug Negotiation Guidance appeared first on Families Usa.

In light of the ongoing U.S. health care affordability crisis, and particularly in the wake of the COVID-19 pandemic, Congress has acted to bolster the amount of assistance available to people in recent years, increasing the premium tax credit amounts under the American Rescue Plan Act (ARPA) and extending those enhancements under the Inflation Reduction Act (IRA). These actions have saved individuals and families money in insurance premiums, but if Congress does not act, this assistance will be cut, and millions of people will face losing their health insurance, delaying or skipping needed health care, or taking on medical debt they cannot afford.

APTCs are having a profound impact in many areas of the country, with metrics differing state-by-state. To cover this more fully, state-specific fact sheets are being created to include breakdowns by area and personal stories of individuals and families benefiting from APTCs. State fact sheets will be added to this webpage on a rolling basis, though not all 50 states will be covered. If you are a state advocate who does not see your state represented and would like to discuss a fact sheet, please contact partnerships@familiesusa.org and the appropriate parties will reach out.

Click the links below to download the national fact sheet and/or state fact sheets.

You can find more advocacy resources on the importance of APTCs here.

The post The Importance of Premium Tax Credits: Affording Health Insurance Coast to Coast appeared first on Families Usa.

We have seen attacks on the use of Mifepristone, a drug used in medication abortion that is safer than Tylenol, and attempts to block or limit access to contraception, IVF treatments, and emergency medical care. Not only does the list go on, but importantly, the message behind these attacks is an affront to a core value of the American health care system: that all patients deserve the best possible care.

However, what state policymakers and anti-abortion extremists did not expect, were the unintended consequences of their actions as it relates to everyday access to essential health care for consumers. As a result of these restrictions and bans, many providers are choosing, sometimes at great cost to their financial security and their own health and wellbeing, to leave their jobs for work in less restrictive states, leaving Americans to pay the price.

As providers become more and more scarce in rural areas, consumers lose access to basic wellness procedures like pap smears, cancer screenings, and exams, directly resulting in poorer health outcomes. This has an outsized impact people of color and those who live in rural communities. Black Americans, American Indian and Alaska Natives are not only more likely to live in states with restrictions or bans, but data shows they have higher uninsured rates and fewer financial resources.

The Dobbs decision exacerbated the existing health care workforce shortage beyond just OBG-YNs. Clinicians report that restrictive abortion policies are “worsening their ability to practice within the standard of care, manage miscarriages and pregnancy related emergencies, and having a negative impact on patient-provider relationships.” Physicians across specialties are leaving to work in states where they feel safe to practice medicine.

Take a trauma surgeon from Texas for example. Having experienced life-threatening complications during her own pregnancy, she understands the fears held by the millions of women who live under abortion bans. Practicing medicine in a state with one of the most restrictive abortion bans in place now in the post-Dobbs era, led her to make the difficult decision to pick up her family and move to the Pacific Northwest.

“I feel that I am actually able to do my job without having to worry about these unintended consequences, or whether someone is going to come after me because they think I contributed to the loss of a fetus…I have a living breathing patient in front of me and that person is my priority… We are having lawmakers with zero medical training making medical decisions and playing doctor that is going to cause a lot of people to die.”

Following in these provider’s footsteps: incoming medical residents.

Rachel, a recent medical school graduate who has just begun her residency, shared with us what she considered when deciding where to continue her path to becoming a provider.

“As I was applying to residency, one of the biggest factors was location. Not just in relation to family or friends but based on where I could learn to provide the highest quality care. As a medical student, I saw how important the full spectrum of reproductive care, including abortion, is to people’s health and as a result, I limited my search to programs in states without restrictions. I am happy to say that I matched into residency in New York and will able to learn, train and practice in an environment that puts patients first.”

Rachel’s story is not unique, one survey found that among third- and fourth-year medical students, nearly 60% said they were unlikely to apply to residency programs in states that restrict abortion. The potential threat of criminal sanctions, loss of their license, and financial risk when providing critical reproductive health care has led to a 6.7% decrease in OB-GYN residency applications in states with total abortion bans in 2024 alone, with individual states reporting even more dire circumstances.

The mass exodus of providers and incoming residents creates a significant challenge for hospitals, primary care providers, and specialists who are not able to meet the demand of health care consumers. And ultimately, it’s the consumers who suffer the most.

But instead of commonsense solutions focusing on access to contraception, sexual education or even addressing the racial discrimination patients face at the doctor’s office, we are faced with ban after ban. Families USA stays committed to fighting for reproductive justice, finding new ways to fill provider shortage gaps, and working toward equitable access to health care for all.

The post Ripple Effects: The Fall of Roe v. Wade appeared first on Families Usa.

In this webinar, Families USA along with David Chase, VP, Policy & Advocacy, at Small Business Majority and Maya Holmes, Healthcare Policy Director, Culinary Health Fund / UNITE HERE Health break down what is at stake and how we can work towards solutions. Also featuring small business storyteller Patrick Hall, CEO & Co-Owner, Élan Flowers & Small Business For America’s Future Network Member.

The post Webinar: The Weight of High Hospital Prices: Keeping Workers and Small Businesses Under Water appeared first on Families Usa.

The time for change is now!

Consumers for Fair Hospital Pricing, a coalition of leading organizations representing families, individuals and health care consumers, has developed a set of legislative policy priorities that focuses on three key areas that are critical to making hospital care higher quality and more affordable for our nation’s families.

The post Consumers for Fair Hospital Pricing Legislative Agenda appeared first on Families Usa.

Our statement for the record recommends members of the committee do the following:

• Continue to work with members of congress to support CMMI in in driving meaningful changes to U.S. health care payment and delivery.
• Increase in the number of mandatory alternative payment models in which providers are required to participate.
• Increase the number of global hospital budget and multi-payer models operated by CMMI to address both high hospital prices and fee-for-service economics.
• Advance the development of a primary care hybrid payment in the Medicare Physician Fee Schedule.

Our statement highlights the ways in which CMMI has already been leading the way by making major investments in the health care system that have trigged key transformational changes to the way health care is paid for and delivered.

The post Families USA Statement for the Record for Hearing on the Transition To Value-Based Care appeared first on Families Usa.