Ideal Model of Care

Bring patients into the health care decision-making and evaluation processes to achieve truly patient-centered health care experience. 

• Develop and use more robust patient-centered value assessments to evaluate the quality of treatments (federal, state). 
• Shift from volume-based “fee-for-service” care toward more value-based care. 
• Establish and expand patient representation on insurance plan committees and other coverage decision-making bodies. 
• Develop and use more robust patient-reported outcomes measures. 

Ensuring patients have access to the providers needed to treat all of their conditions and focus on outcomes that matter to patients.

• Better Care Coordination  
  • Access to health care coordinators and services. 
• Ensuring Access to Needed Providers and Services 
  • Adequate provider networks. 
  • Loan repayment program to train more professionals in arthritis-related care. 
  • Access to biomarker testing. 
  • Insurance coverage for complementary/alternative therapies. 
  • Access to evidence-based treatments. 
  • Remove caps on the number of visits permitted in a plan year for physical therapy, occupational therapy, or other allied health professional visits. 
  • Dental coverage. 

Improving care through technological solutions and opportunities including expanded telehealth, interoperable health records and more.  

• Access to real-time benefits tools. 
• Electronic medical records that are interoperable across healthcare providers and systems. 
• Telehealth access for regions that lack adequate providers.
• Improved digital health infrastructure. 

Addressing barriers to health system costs and insurance coverage.

• Lowering Out-of-Pocket Costs 
  • Caps on out-of-pocket costs for specialty drugs. 
  • Access to biosimilars. 
  • Copay assistance protection. 
  • Point-of-sale rebates. 
  • Allowing more flexibility in High Deductible Health Plans to provide continuous care for arthritis without barriers from unaffordable deductibles. 

• Reforming Utilization Management of Treatments 
  • Reform prior authorization. 
  • Eliminate mid-year formulary changes. 
  • Reform step therapy. 
  • Streamline processes to access health coverage. 
  • Ensure continuity of treatment through insurance changes. 

Seeking solutions to address health disparities with consideration of each patient’s background. 

• Addressing social determinants of health through Medicaid coverage in assessing the value of treatments. 
• Improving clinical trial diversity. 
• Call for better data collection to more effectively allocate resources in areas of need.