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:

  • Met with the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center to discuss the Medicare Shared Savings Program and ACO Realizing Equity Access and Community Health (REACH).
  • Met with members of the House Budget Committee’s Health Care Task Force (HCTF) to discuss the CMS Innovation Center and efforts to enhance accountable care models that deliver better health outcomes at a lower cost.
  • Convened our Specialty Care Committee to discuss recently released shadow bundle data for ACOs as part of CMS’s specialty care strategy.
  • Met with Senate Finance Committee to discuss upcoming hearing on chronic care.

Register for our next Double Click on Accountable Care – May 14th, in Washington, DC.

Congressional News

The House and Senate will return next week for a two-week work period.

Outlook for Health Policy as Congress returns to D.C. Following a two-week recess, policymakers will be back in DC next week and will return to focus on several health care issues. Notably, the Senate Finance Committee has announced a hearing, “Bolstering Chronic Care through Medicare Physician Payment.” The April 11 hearing will focus on how Medicare pays physicians and non-physician practitioners for chronic illnesses such as cancer, diabetes, and heart disease. A4H has been working closely with the Committee as they organized the hearing and we are excited to have A4H member, Melanie Matthews, MS of Physicians of Southwest Washington, serving as an expert witness.

Administration

CMS Releases Medicare Advantage Payment Rates for 2025 and Technical Rule. The finalized policy is closely aligned to the Advance Notice that was released earlier this year. CMS expects the change in revenue for Medicare Advantage (MA) plans for 2025 to be 3.70 percent, consistent with the proposed rate announcement. The CMS fact sheet on the Rate Announcement can be found here. CMS also released the Medicare Advantage and Part D final rule including policies related to agent and broker compensation, marketing, supplemental benefits and prior authorization. The CMS fact sheet on the MA and Part D final rule can be found here.

Resources

CMS Innovation Center Highlights New Quality Pathway in NEJM Blog. In a blog post in the New England Journal of Medicine (NEJM), the Innovation Center highlighted its new Quality Pathway, intended to align model design around quality goals, elevate outcomes and experience measures and ensure that evaluations are better designed to assess the impact of models on quality goals. The agency authors discuss the importance of quality in an overall assessment of model performance and, ultimately, in decisions as to whether models or model elements should be expanded nationally. The Quality Pathway approach will promote novel collection of data, developing approaches for quality comparisons, and development and testing of new measures to address gaps. A4H will continue to engage with CMS and the Innovation Center about how successful approaches to quality measurement and evaluation can bolster support for effective accountable care.

CMS Innovation Center Updates Specialty Care Strategy in Health Affairs Blog. Featured in Health Affairs Forefront, the CMMI blog post emphasizes the role of specialty care in the comprehensive approach to accountable care. The post provides updates on the Innovation Center’s progress toward implementing its four pathways for specialty care coordination and integration:

  • Enhancing data transparency in specialty care performance;
  • Maintaining momentum on acute episode payment models and condition-based models;
  • Creating financial incentives within primary care for specialist engagement; and
  • Creating financial incentives for specialists to affiliate with population-based models and move to value-based care.

In the blog, the Innovation Center also affirms its commitment to supporting both primary and specialty care practices and to reaching its 2030 goal of achieving accountable care for Medicare and Medicaid beneficiaries. This week, A4H’s Specialty Care Committee met to discuss new shadow bundle data made available to ACOs, and how ACOs can use that data to inform their specialty care strategies.

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