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

Health Care Value Week

Accountable for Health is pleased to work with over 60 stakeholder organizations to support Health Care Value Week, January 29 to February 2, a week of action to support value-based care education and advocacy. We invite our members and friends to participate in the following Value Week events (please note separate registrations):

  • A4H and House Health Care Innovation Caucus: Innovation Showcase on Capitol Hill (in person) – on January 31, A4H and the House Health Care Innovation Caucus will host an Innovation Showcase in the Rayburn Building highlighting A4H members’ approaches to improving health care delivery (register here).
  • A4H @ Health Care Value Week (in person) – on February 1, A4H is hosting a half-day conference in Washington, DC, featuring panel discussions about accountable care. The agenda includes Representative Darin LaHood (R-IL); Liz Fowler, Director of the CMS Innovation Center; Sarah Levin, Professional Staff, House Ways and Means Committee; Conor Sheehey, Senior Health Policy Advisor, Senate Finance Committee (register here).
  • Virtual Value Based Payment Summit. The virtual conference agenda includes panels featuring Former Governor and Former HHS Secretary, Kathleen Sebelius; Former HHS Secretary, Alex Azar; Dr. Mark McClellan, Director, Duke-Margolis Center for Health Policy; Dr. Meena Seshamani, Director of the Center for Medicare; Dan Tsai, Director of the Center for Medicaid and CHIP Services; Liz Fowler, Director of the CMS Innovation Center; and Jon Blum, Principal Deputy Administrator and Chief Operating Officer, CMS (register here).

To view a full schedule of Health Care Value Week events, visit: hcvalueweek.org.

Congressional News

The Senate and House will both be in session next week and are expected to continue to focus on government funding.

Government Funding and Health Care Package Outlook. On January 7, Speaker of the House Mike Johnson (R-LA) and Senate Majority Leader Chuck Schumer (D-NY) announced an agreement on topline fiscal year 2024 government funding levels. Following this agreement, the appropriation committees began negotiating and drafting text for the individual bills ahead of the two funding expirations, one on January 19 and one on February 2. The bipartisan agreement would allocate $886 billion for defense spending and $773 billion for non-defense spending. However, with only a few legislative days ahead of the deadline, and concerns within the House Republican conference, a short term extension may be more likely and a shutdown remains possible. We will know more when Congress returns next week.

In the meantime, with an agreement on topline funding, healthcare committees continue to negotiate the parameters of a broader healthcare package which could be passed alongside a funding bill. Several previously extended health provisions expire on January 19. In addition, both the House and Senate advanced bills before the holidays with health care provisions, including hospital and insurer price transparency, pharmacy benefit manager (PBM) reforms, and site neutral payments. Proposals also addressed the reduction to Medicare physician fee schedule payments and extending the advanced alternative payment model (APM) bonus. View the A4H table comparing APM bonus extension proposals here. We expect ongoing negotiations over this provision, with cost being a primary concern factoring into what is ultimately passed. A4H continues to weigh in with Congressional offices and committees to urge action on the APM bonus.

Administration

Health Equity Initiative Feedback. The Centers for Medicare and Medicaid Services (CMS) Innovation Center released a fact sheet summarizing attendee feedback from a series of meetings on implementing the Health Equity Initiative, part of the Center’s strategy refresh. These meetings addressed issues preventing equitable health outcomes for Americans such as a lack of sustainable and flexible funding sources and streamlined data collection methods. Attendees suggested incentivizing value-base care models and an emphasis on preventative care to address health-related social needs. Attendees also highlighted the need for multi-payer alignment and streamlining data collection. This work will continue to inform the Center’s work to incorporate health equity elements in current and future models.

Next Gen ACO Model Evaluation finds Care Improvements and Net Savings in Final Performance Year. The Next Generation ACO model ran from 2016 through 2022, testing two-sided risk and alternative payment approaches for providers. The final evaluation report finds that Next Generation ACOs “consistently demonstrated success in lowering gross expenditures for their aligned beneficiaries without adversely affecting quality of care,” reduced utilization in the most intensive care settings, and increased the use of preventive care for their populations. The evaluation highlights how the Next Gen ACO model stimulated grew organizational capacity and strengthened relationships across the continuum of care. In addition, during the Public Health Emergency, Next Gens leveraged robust infrastructure to support beneficiaries and providers. Over the course of the model, net savings were neutral, until the sixth performance year, when net spending declined by 2.4 percent. These findings may support recent CMS Innovation Center approaches that favor longer models and underscore the care transformation that is improving health outcomes and patient experiences.

ESRD ETC Model Evaluation Report. CMS released an evaluation report on the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model years 2021-2022. This model covers approximately 30% of Hospital Referral Regions (HRRs) in the U.S., and participation is mandatory for dialysis facilities and clinicians in selected HRRs. Performance-based payment adjustments are based on levels of home dialysis use, waitlisting for a deceased donor transplant, living donor transplant, and in some cases pre-emptive transplant. In the first two years of the model, the evaluators found limited evidence of an impact of the model, however, the evaluators cautioned that it is too early to form conclusions about the possible longer-term impacts of the model.

Four Things We’re Reading

  1. Medicare Advantage Program: Status Report (MedPAC)
  2. Engaging Specialists in Accountable Care: Tailoring Payment Models Based on Specialties and Practice Contexts (Health Affairs Part 1) and Next Steps for Engaging Specialty Care in ACO Models (Health Affairs Part 2)
  3. The CBO Report That Didn’t Roar (KFF)
  4. Value-Based Care in State Medicaid Programs (National Conference of State Legislatures)

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