Patient Access to Prescription Drugs

• Patient Access: The ACC advocates for affordable access for all patients, regardless of insurance coverage or lack thereof, to all approved prescription drugs with scientific evidence of net clinical benefit or as articulated in clinical practice guidelines.
• Barriers: Excessive out-of-pocket expense represents an insurmountable hurdle for many patients. It is essential to diminish any financial barriers including co-pays, co-insurance and deductibles. In addition, the ACC calls for the reduction of administratively burdensome processes that hamper patient access to evidence-based, approved therapies.
• Transparency: The ACC urges transparency toward price determination throughout the distribution chain. Accurate information on drug prices, plan benefits, formulary changes and discounts must be made readily available, so clinicians and patients can be better informed about expected cost-sharing when discussing treatment plans.
• Value-Based Pricing: Pricing decisions should be made with an emphasis on value, as assessed through scientific evidence and analysis of both comparative effectiveness and cost-effectiveness. Any movement toward value-based pricing must prioritize the impact on patient outcomes and not consider cost as the sole criteria.

Medicaid

The ACC supports expanded access to and the prevention of loss of health care coverage through public and private programs, especially access to affordable coverage options for the treatment of cardiovascular disease. In 2016, more than one-quarter of the U.S. population was enrolled in Medicaid or the Children's Health Insurance Program (CHIP) at some point during the year – an estimated 82.2 million for Medicaid and 9.2 million for CHIP.

Therefore, the College:

• Supports the expansion of health care coverage through public and private programs, including working with chapters and stakeholders to support Medicaid expansion where feasible
• Promotes patient access to high-quality care through appropriate payment for services provided under Medicaid
• Promotes patient-centered coverage that provides appropriate access to clinicians and services, including primary, preventive, rehabilitative and specialty care

Reducing Administrative Burden

Excessive administrative tasks that are not central to direct patient care can lead to delayed or missed patient care, clinician dissatisfaction and workplace burnout. These principles are intended to guide ACC's advocacy efforts aimed at minimizing or eliminating barriers to efficient, high-quality cardiovascular care in all practice settings by addressing administrative burdens imposed by government programs and private health plans in the following three areas:

• Optimize EHR workflow designs to increase operational efficiency and productivity while continuing to improve quality care
• Advocate for and adopt consensus methods and standards that allow effortless data transmission, extraction, interpretation and manipulation to ensure interoperability on all medical devices and platforms

Prior Authorization and Payment:

• Standardize prior authorization requirements in accordance with national clinically supported guidelines and criteria developed by medical societies
• Streamline documentation requirements, e.g., reduce the number of mandatory evaluation and management (E/M) documentation elements or quantity of information necessary for Family and Medical Leave Act (FMLA) forms
• Simplify coding guidelines across clinical care settings, including increased alignment with standardized coding requirements and clinical documentation among payers
• Improve patients' access to timely and appropriate care by working with all stakeholders to reduce insurer-denials of physician-recommended services

Quality Measurement

• Adopt relevant, standardized, actionable, evidence-based quality measures based on the clinician's medical specialty/subspecialty
• Promote transparent and timely exchange of robust and meaningful measurement data from government and payer programs
• Streamline and prioritize quality measures across government and payer programs
• Minimize the operational burden of quality management programs

Digital Health

Digital health encompasses a broad scope of tools that engage patients for clinical purposes; collect, organize, interpret and use clinical data; and manage outcomes and other measures of care quality. This includes, but is not limited to, digital solutions involving telemedicine and telehealth, mobile health, wearables, remote monitoring, apps and others.

The following principles guide the College's support of digital health initiatives:

• Enable patient engagement and shared-decision making in care delivery by providing clinicians and patients with improved access to personalized health information
• Conduct research into appropriate use and integration of digital health into cardiovascular care to ensure patient safety, care quality and positive health outcomes
• Improve the patient experience, care quality, patient safety and outcomes without hampering clinical workflow
• Foster the development, adoption and evolution of practices that optimize data security, privacy, use, and sharing, as well as device security and safety
• Adopt and utilize standardized approaches for seamless data transmission, integration, aggregation and analysis
• Ensure clinicians and health systems are compensated appropriately for the integration of digital solutions into patient care
• Require clinicians to provide services as authorized by state licensure boards