The House and Senate will be in session next week.

The 119th Congress Begins. The House and Senate returned to Washington, DC, on January 3 to start the 119th Congress. Speaker of the House Mike Johnson (R-LA) was re-elected to his position, although not without some pushback from more conservative members of his conference, highlighting the challenges the House will face advancing legislation with tight margins. Republicans in the House and Senate are now focused on advancing a tax, energy, and immigration-focused reconciliation package. A4H is encouraging lawmakers to also address key health care programs and priorities, including mitigating physician pay cuts and extending Advanced Alternative Payment Model bonuses as they grapple with extending government funding beyond the March deadline. 

Health Care Committee Leadership. Several new congressional leaders have taken positions on key health care committees. Rep. Brett Guthrie (R-KY) will chair the House Energy and Commerce (E&C) Committee, and Rep. Frank Pallone, Jr. (D-NJ) will return as Ranking Member. Rep. Buddy Carter (R-GA) will chair the E&C Health Subcommittee. At the House Ways and Means Committee, Reps. Jason Smith (R-MO) and Richard Neal (D-MA) return as Chair and Ranking Member, respectively. Rep. Tim Walberg (R-MI) will chair the House Education and the Workforce Committee, and Rep. Bobby Scott (D-VA) will return as Ranking Member. In the Senate, Sen. Bill Cassidy (R-LA) will chair the Health, Education, Labor, and Pensions (HELP) Committee, and Sen. Bernie Sanders (I-VT) will be Ranking Member. Sen. Mike Crapo (R-ID) will chair the Senate Finance Committee, and Sen. Ron Wyden (D-OR) will be Ranking Member. A4H will continue to engage with these key stakeholders to advance the transition to accountable care.  

Finance Chairman Releases Priorities. In a press release, the new Chairman of the powerful Senate Finance Committee, Mike Crapo (R-ID), outlines key priorities for the 119th Congress. Chairman Crapo’s priorities range from tax, trade, health care, and social security. In a section on health care, Chairman Crapo said, “The Committee must also streamline clinician payment systems and incentivize alternative payment models that reward providing better care at a lower cost. We must improve primary care, support chronic-care benefits in Medicare, and provide Medicare doctors with long-term payment stability.” A4H welcomes these comments and will continue to work closely with Chairman Crapo and other members of the Finance Committee to achieve these goals.  

Cures 2.1 White Paper Released. Representatives Diana DeGette (D-CO) and Larry Bucshon (R-IN) issued a white paper outlining the next steps for Cures 2.1 and the 21st Century Cures Initiative. Drawing from comments received on the request for information (RFI) on the 21st Century Cures Initiative issued last summer, the white paper identifies areas for consideration for Cures 2.1, including increasing access to preventive care (including through telehealth), improving clinical trials, improving the use of health IT, expanding the use of real-world data and real-world evidence, improving Medicare coverage and payment policies, and addressing artificial intelligence (AI) in health care. In May 2024, A4H submitted comments in response to the 21st Century Cures Initiative RFI, advocating for greater attention to and investment in health IT to increase the adoption of accountable care and to leverage health information to advance the goals of accountable care. We are glad that the Cures 2.1 white paper considers ways to strengthen health IT and make medical records more usable to improve patient care. A4H will continue engaging with the 21st Century Cures Initiative to discuss how the legislation can prepare the health IT ecosystem for the transition to accountable care.

15 States Selected to Participate in the TMaH Model. The CMS Innovation Center announced the 15 state Medicaid agency (SMA) participants for the Transforming Maternal Health (TMaH) Model: Alabama, Arkansas, California, the District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, and Wisconsin. The TMaH Model is a 10-year model intended to improve maternal health care for people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) by assisting SMAs in implementing whole-person pregnancy, childbirth, and postpartum care. The TMaH Model will also test a value-based payment system. In model years (MY) 1-3, SMAs will receive technical assistance and use part of their funding to pay for care delivery transformation activities and data infrastructure. In MY4, providers will be eligible for upside-only performance incentive payments. Starting in MY5, SMAs will transition to a value-based payment model, which includes payments to providers based on quality and cost outcomes. A4H continues to engage with CMS to guide model design and advance accountable care arrangements in Innovation Center models.

CMS to Cancel VBID Model After Calendar Year (CY) 2025. CMS announced that the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model would end after CY2025, saying that the decision to end the model is based on “substantial and unmitigable cost” to the Medicare Trust Fund. CMS reflected on lessons from the VBID Model, including strategies to improve population health outcomes enabled by screening for health-related social needs, improve transparency in MA, and increase medication adherence through reduced Part D patient cost sharing. According to the announcement, patients can access many of the same wraparound services and supplemental benefits VBID enabled, like transportation to medical appointments, because those services can now be offered in the MA program.

CMS in NEJM: Changing Medicare Payment to Strengthen Primary Care. CMS published an article in the New England Journal of Medicine on coding and payment policies in the 2025 Physician Fee Schedule (PFS) for advanced primary care management (APCM) services. The article describes the APCM payment system, highlighting CMS’ hope that the new codes will reduce administrative burden and enable primary care physicians to provide the services a patient’s clinical circumstance calls for. CMS also spotlights the success of ACOs comprised of mostly primary care practitioners and discusses the Innovation Center’s investment in primary care and accountable care through the Primary Care Flex Model, the Making Care Primary Model, and the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. CMS concludes with the hope that Medicare payment changes will “set the stage” for larger shifts in commercial and state Medicaid policies, ultimately transforming payment systems so that primary care physicians are supported, and patient outcomes and experiences are improved. 

Town Hall Ventures Outlook for 2025. In a new perspective, Town Hall Ventures outline’s themes and predictions for health care policies under the Trump administration and the new Congress. The article highlights nine subjects where Town Hall Ventures anticipates significant changes may occur, including artificial intelligence (AI), chronic diseases and health outcomes, Medicare Advantage, CMS Innovation Center models, and drug pricing reforms.  

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

• Register for A4H In-Person Value Week Event, February 25. A4H will host a day-long in-person conference in conjunction with Health Care Value Week in Washington, DC. Hear Congressional, Administration, community and provider perspectives on accountable care. Sessions include state approaches to affordability, data and health information technology, and clinical perspectives to advance health care delivery. This event is complimentary and open to members and non-members of Accountable for Health. You can register and view the full list of speakers on our website. An agenda will be posted shortly.
• A4H In-Person Innovation Showcase, February 26. A4H and the Innovation Caucus will host a showcase at the Rayburn House Office Building from 11am to 1pm. Attendees can walk through the Rayburn foyer and visit A4H member displays to hear first-hand their approaches to accountable care. Register here.
• Virtual Value-Based Payment Summit, February 24-28, the Virtual Health Care Value week conference is a week-long series of sessions featuring speakers on a variety of value-based care topics. You can register and view the full list of sessions on their website.