- Patients will have an active and formal voice in health system transformation including payment and delivery system reform; Systemic efforts to contain costs, assess the value of care and treatment, and generate the best outcomes at a reasonable cost should be patient-centered.
- Patients have the right to dignified, culturally competent quality health care.
- Patients will have limited cost sharing and will have predictable and affordable total out-of-pocket costs, including deductibles, co-pays, co-insurance, premium costs or contributions to premiums across care settings.
- Patients will have easily understood and accessible up to date information about covered services, providers, formularies and out-of-pocket costs in all insurance plans during enrollment periods and throughout the year.
- Patients will have reasonable and timely access to all necessary providers in their network and network providers will be within a reasonable distance.
- Patients will pay in-network rates with payments credited to out-of pocket limits for all services provided at in-network settings.
- Patients will have access to necessary medications, services, devices, and other care without discrimination through unreasonable tiering or excessive cost-sharing.
- Patients will not be subject to cumbersome preauthorization and renewal processes that restrict access to care and therapies — including prescriptions and devices.
- Patients will have easily understood and accessible up to date information and guidance regarding appeals, including timely access to a rapid and fair appeals process.
Click here to read our Health Care Principles, which guide our efforts regarding health reform.