Welcome to the Accountable for Health (A4H) newsletter, including legislative and Administration updates, accountable care news, and resources.

A4H Activity

A roundup of our recent activity in Washington, DC:

  • A4H member Melanie Matthews, CEO of PSW, served as an expert witness during a Senate Finance Committee Hearing focused on physician payment reforms. Matthews’s testimony highlighted how accountable care provides critical support to communities, emphasizing the need for program stability and incentives, and underscoring the benefits to patients.
  • A4H met with members of the House Budget Committee’s Health Care Task Force to discuss the CMS Innovation Center and efforts to enhance accountable care models.
  • Convened the A4H Voices of Accountable Care Committee for a in person meeting in Washington, DC to discuss efforts to advance accountable care in communities.
  • Met with Senate Budget Committee Ranking Member Chuck Grassley (R-IA) to discuss the Healthy Moms and Babies Act and efforts to expand maternity alternative payment models.

Register for the Double Click on Accountable Care – May 14th, in Washington, DC. Agenda now available.

Congressional News

The House and Senate are scheduled to be in recess next week. The House will remain in session over the weekend to consider national security supplemental legislation.

Congressional Budget Office Report Highlights ACOs Cost Savings, Recommends Expanding Participation, Incentives. The non-partisan Congressional Budget Office (CBO) issued a report that found certain types of ACOs, including those led by independent physician groups, those with larger proportions of primary care providers, and those with higher baseline spending than the regional average all contributed to greater savings for the Medicare program. In addition to these findings, CBO recommends approaches to enhance ACO savings in Medicare, such as increasing provider participation incentives, increasing incentives to reduce spending, and improving beneficiary awareness and engagement. A4H is encouraged by CBO’s findings, which support our calls for greater flexibility in payment mechanisms, extending the alternative payment model bonus, and encouraging greater participation in effective accountable care.

Senate Finance Committee Holds Hearing on Medicare Physician Payment and Chronic Care. During the hearing Senators discussed Medicare Advantage (MA); the Medicare Access and CHIP Reauthorization Act (MACRA); and accountable care organizations (ACOs) among other things. Ranking Member Mike Crapo (R-ID) asked how CMS and Congress can promote participation in MIPS or A-APMs, and Sen. Debbie Stabenow (D-MI) asked witnesses how APMs can help expand quality in Medicare. Sen. Sheldon Whitehouse (D-RI) urged support for the Value in Healthcare Act to enhance ACOs’ ability to improve and invest in patient care and discussed new legislation that would offer hybrid payment approaches for primary care services in traditional Medicare. A4H continues to work with the Senate Finance Committee and members of the Senate Working Group on Medicare Payment Reform to advance policies that accelerate adoption of accountable care.

HHS Secretary Becerra Testifies Before Congress. Health and Human Services (HHS) Secretary Xavier Becerra was on Capitol Hill this week to testify regarding the President’s FY25 budget. During his testimony, Secretary Becerra took questions on Medicare Advantage (MA), consolidation in health care, telehealth, site neutral payments, and pharmacy benefits managers (PBMs), among other topics. A4H continues to work with lawmakers to underscore the importance of accountable care and has submitted several questions to Secretary Becerra regarding advancing accountable care delivery which will be a part of the final hearing record.

Congressional Medicare Advisors Highlight Value of Extending APM Bonus. During their April public meeting the Medicare Payment Advisory Commission (MedPAC) held a session on updating the Medicare Physician Fee Schedule. As a part of that session MedPAC discussed three potential policy approaches to update Medicare payments:

  • Update practice expense portion of fee schedule payment rates by the hospital market basket index minus productivity;
  • Update payment rates by Medicare Economic Index minus one percentage point;
  • Extend the Advanced Alternative Payment Model (A-APM) participation bonus for 2-3 years.

Several commissioners highlighted the importance of A-APM bonuses and recognized that extending the bonus would provide stability and predictability for physicians. A4H will continue to monitor MedPAC’s recommendations and work with lawmakers to encourage the extension of advanced APM bonuses to create strong and clear incentives to move away from fee-for-service toward alternative forms of payment that prioritize health outcomes.

Administration

CMS Releases FY 2025 IPPS Proposed Rule and New Mandatory Innovation Center Model. CMS plans to increase payments to inpatient hospitals by 2.6 percent, increasing hospital payments by $2.9 billion. The proposed rule also includes a provision creating a new mandatory episode-based CMS Innovation Center model, the Transforming Episode Accountability Model (TEAM). Under TEAM, selected acute care hospitals would connect certain surgical patients to coordinated, high quality care, including referring patients to primary care services. CMS is seeking comment on the TEAM proposal. We anticipate that the final rule will be published in the fall 2024. A detailed fact sheet on TEAM can be found here. A4H members discussed TEAM on our Total Cost of Care Committee call this week and will plan to submit comments in response to the proposed rule.

Maryland Total Coast of Care (TCOC) Model Had Favorable Effects. CMS released an updated evaluation of the state-based model reflecting 2019-2022 performance. The Maryland model uses hospital global budgets and incorporates investments in primary care in an effort to engage providers in care transformation across the state. In addition, episode-based payments allow specialists to share in savings from preventing complications and unnecessary care. The report found that the model had positive effects on spending, service use, and quality:

  • Reduced total Medicare spending, generating $689 million in net savings to traditional Medicare over the first three years;
  • Reduced disparities in unplanned readmissions and preventable admissions;
  • Improved timely follow-up after hospitalizations and emergency department visits.

A CMS factsheet on the model can be found here. CMS plans to build on the success of global budget approaches with its new model, States Advancing All-Payer Health Equity Approaches and Development (AHEAD).

Resources

Health Care Leadership Council Recommends Ways to Accelerate Value-based Care. The Health Care Leadership Council (HLC), an association of executives from multi-sectoral health care organizations, released several recommendations to advance value-based care. The recommendations include:

  • Encouraging provider participation in global risk models such as ACO REACH.
  • Improving data integration and interoperability.
  • Designing care models that go beyond the clinical setting and meet patients where they are.

A fact sheet can be found here. A4H was pleased to participate in this roundtable discussion with HLC and several of our member companies.

Value-Based Care Payment Recommendations Playbook. AHIP, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) published a playbook on voluntary best practices for value-based care arrangements in the private sector. The playbook highlights different approaches like developing patient attribution methods, creating financial benchmarks, and methods to ensure risk adjustments reflect patient populations. The playbook is divided into seven categories: payment attribution, benchmarking, risk adjustment, quality performance impact on payment, levels of financial risk, payment timing and accuracy, and incentivizing for value-based care practice participant performance. The playbook can be found here.

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