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

Health Care Value Week Recap

Last week, over 3,000 people participated across virtual and in-person events as part of the third annual Health Care Value Week. Accountable for Health hosted two in-person events in Washington, DC:

  • A4H and the House Health Care Innovation Caucus, hosted an Innovation Showcase on Capitol Hill, highlighting A4H member efforts to improve care delivery.
  • A4H hosted a half-day conference featuring panel discussions and presentations from government officials, industry leaders, and our partner organizations. The event highlighted successes in accountable care and outlined policy opportunities on the horizon to accelerate the movement to accountable care.

As part of Health Care Value Week, the CMS Innovation Center launched the Value-Based Care Spotlight website, announced the new Cell and Gene Therapy (CGT) Access Model; and released new data showing an increase in participation in accountable care models.

Thank you to all of the organizations and individuals who participated for making Health Care Value Week a success!

Congressional News

Next week the House will be in session and the Senate will be in recess.

Government Funding and Health Care Package Outlook. Lawmakers are continuing to negotiate the parameters of government funding legislation ahead of the March 1 and March 8 deadlines. The key health care committees in the House and Senate continue to discuss a broader health care package which could potentially pass alongside a funding bill. As we mentioned in previous newsletters, the House and Senate have advanced policies that would address hospital and price transparency, pharmacy benefit manager reforms, and site neutral payments. Both chambers also have advanced legislation to address the reduction to Medicare physician fee schedule payments and extend the advanced alternative payment model (APM) bonus. A4H continues to work with Members of Congress to push for the inclusion of an APM bonus fix and progress has been made however, the overall cost will remain a concern and could impact how far a fix could go. View the A4H table comparing APM bonus extension proposals here.

Senators Announce MACRA Working Group. Senators Cortez Masto (D-NV), Blackburn (R-TN), Thune (R-SD), Barrasso (R-WY), Stabenow (D-MI), and Warner (D-VA) announced the formation of a working group to propose long-term reforms to the Medicare Physician Fee Schedule and make necessary updates to the Medicare Access and CHIP Reauthorization Act (MACRA). A4H looks forward to working with these lawmakers to develop and advance policies that accelerate the movement to accountable care.

Administration

CMS Proposes 3.7% Increase for Medicare Advantage (MA) Plans in 2025. The agency released the MA 2025 advance notice proposing updates to plan payments. The CMS estimate includes a +3.86% risk score trend factor, an effective growth rate of 2.44%, and the continued phase in of risk adjustment changes finalized last year. Some plans have cautioned that risk score trend may be overstated and the actual 2025 estimated update is closer to -0.16%. We expect plans and some stakeholders to seek to convince CMS to increase certain factors, pressing for a higher final Rate Announcement on or before April 1. A CMS fact sheet and FAQ with more details on the 2025 Advance Notice can be found here.

CMS Announces Continued Growth of Accountable Care Initiatives in 2024. The agency announced updated numbers across the ACO Realizing Equity, Access, and Community Health (ACO REACH), Kidney Care Choices, and the Medicare Shared Savings Program as CMS continues to pursue its goal of having 100% of Medicare beneficiaries in accountable care models by 2030.

  • The ACO REACH Model is serving approximately 2.6 million traditional Medicare beneficiaries through 122 ACOs, more than 173,000 providers and organizations, and more than 1,000 Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals.
  • The Kidney Care Choices is serving more than 282,000 chronic kidney disease and end stage renal disease Medicare beneficiaries this year through 123 Kidney Contracting Entities and CMS Kidney Care First Practices and more than 9,000 providers and organizations.
  • The Medicare Shared Savings Program is serving over 10.8 million people with traditional Medicare through 480 participating ACOs, including 19 newly formed ACOs that are participating in a new 2024 payment option allowing for ACOs to receive advance investment payments for providing care to underserved populations.

CMS Announces Sickle Cell Disease as Initial Focus of CGT Access Model. The model aims to improve health outcomes for Medicaid beneficiaries by supporting outcomes-based agreements between states and pharmaceutical manufacturers. The voluntary model tests whether a CMS-led approach to developing and administering outcomes-based agreements for certain therapies improves access to treatments, improves outcomes, and reduces costs to state Medicaid programs. The model will initially test expanding access to gene therapy for sickle cell disease. More information about the model can be found on the model webpage. CMS estimates it will release a Request for Applications to manufacturers in the early spring and Notice of Funding Opportunity to states in summer 2024.

Four Things We’re Reading

  1. Improving Access through Value-Based Care (Berkeley Research Group)
  2. Vermont ACO Model Ties Payer, Provider Payment to Care Quality (Healthcare Finance)
  3. Overcoming the Barriers to Value Based Payment in Primary Care (RevCycle Intelligence)
  4. Dialysis from the Comfort of Home: Letisha’s Story (CMS, Value-Based Care Spotlight)

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