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:

  • In advance of the House Energy and Commerce, Subcommittee on Health hearing on the Centers for Medicare & Medicaid Services (CMS) Innovation Center A4H provided subcommittee members with materials, including two reports highlighting models that have saved money and increased access to care (more on the hearing below).
  • A4H met with Energy and Commerce Health Subcommittee Chairman Brett Guthrie (R-KY) to discuss expanding ACO models and providing more certainty for accountable care model participants.
  • A4H met with Vice Chairs of the New Democrat Coalition’s Health Care, Substance Use and Mental Health Task Force, Reps. Yadira Caraveo (D-CO) and Brittany Pettersen (D-CO) to discuss accountable care delivery, including value-based maternity and behavioral health models.
  • A4H submitted comments on the proposed Transforming Episode Accountability Model (TEAM). Our comments shared lessons learned from previous episode-based models, specific feedback on elements of TEAM, and continued to encourage development and implementation of a robust specialty care engagement strategy.

Congressional News

House Energy and Commerce Health Subcommittee Hearing on the CMS Innovation Center. Center Director Liz Fowler testified and answered questions from lawmakers about the Innovation Center’s portfolio, model savings, approaches to new model development, and oversight of the Center’s funding. In the lead up to the hearing, A4H worked closely with lawmakers to provide background materials and context for the hearing on topics including kidney care models, model expansion criteria, models for high needs beneficiaries, and the overall success of accountable care delivery. Several lawmakers, including the full Energy and Commerce Committee’s Chair and Ranking Member, praised ACOs for their cost efficiency and ability to incentivize the delivery of high-quality care. Overall, many lawmakers expressed support for the Innovation Center’s goals and asked specific policy questions about model design and participation. A4H was pleased to see bi-partisan support for delivery system reform efforts. A complete summary of the hearing is available here. The hearing is the latest in ongoing discussions focused on physician payment reforms. A4H continues to work closely with the Committee as lawmakers consider short- and long-term policies that strengthen accountable care.

A4H Responds to Senate Finance Committee White Paper. A4H joined liked minded stakeholders for a meeting with bipartisan staff of the Senate Finance Committee to discuss responses to the Committee’s white paper on physician payment reform. The discussion focused on short- and long-term reforms to Medicare’s payment systems, including incentives for participating in advanced alternative payment models, reforms to the merit-based incentive payment system (MIPS), and opportunities to improve current models. A4H also submitted written comments to the Committee. A4H expects multi-component discussions to continue on Capitol Hill, with potential action on physician pay and other healthcare priorities after the November elections and then a longer-term effort to overhaul the Medicare Access and CHIP Reauthorization Act (MACRA), likely taking several years.

MedPAC Weighs in on Future of Physician Payment, including Alternative Payment Models. The Medicare Payment Advisory Commission (MedPAC) June 2024 Report to Congress considers approaches for updating Medicare Physician Fee Schedule payments and incentivizing participation in advanced alternative payment models (APMs). The report notes that “many A-APMs have yielded sufficiently promising results or sufficiently actionable lessons learned that they have been refined and relaunched as successor models. In the absence of A-APMs, FFS payment approaches would likely have fewer incentives to promote efficiency.” In light of these findings, the report discusses considerations for an A-APM bonus that is more attractive than MIPS, and ensuring continued directional support for increasing participation in A-APMs. The report also examines Medicare Advantage prior authorization, provider networks, and encounter data.

Administration

CMS Holds ACO Primary Care Flex Model Webinar. The webinar provided information on the application for the ACO Primary Care Flex Model. This new five-year voluntary Model will focus on primary care delivery in the Medicare Shared Savings Program (MSSP). It will test how prospective payments and increased funding for primary care in ACOs impact health outcomes, quality, and costs of care. CMS has released a Request for Applications (RFA) and a companion workbook for the Model. Organizations interested in participating must apply to MSSP by June 17, 2024. Applicant ACOs must also submit a supplemental ACO PC Flex application questionnaire by August 1, 2024. CMS plans to announce applicants selected to participate in October 2024. A CMS fact sheet on the ACO PC Flex Model is available here, and the model webpage is available here.

CMMI Director Fowler Speaks at Physician-Focused Payment Model Technical Advisory Committee (PTAC) Meeting. The meeting focused on patients with complex chronic conditions or serious illnesses in Population-Based Total Cost of Care Models. Director Fowler’s remarks emphasized the importance of integrating palliative care; she highlighted flexibilities in ACO REACH and the Kidney Care Choices (KCC) Model and commended the Guiding an Improved Dementia Experience (GUIDE) Model. Director Fowler also identified an opportunity for the Innovation Center to continue partnering with primary care providers to increase access to palliative care.

CMS Release 2023-2032 National Health Expenditure (NHE) Projections. The CMS Office of the Actuary estimates that from 2023-2032, the average annual growth in NHE (5.6 percent) will outpace the average annual growth in GDP (4.3 percent), resulting in an increase in health spending share from 17.3 percent in 2022 to 19.7 percent in 2032. The average annual Medicare expenditure growth is projected to be 7.4 percent from 2023-2032. CMS also estimates that hospital spending growth will average 5.7 percent across the decade. Physician and clinical services are projected to rise by 5.6 percent, and retail prescription drugs are expected to grow by 6 percent over the decade. A link to NHE projections can be found here, and an overview written in Health Affairs can be found here.

Resources

CMMI Provides an Update on Health Equity Strategy in Health Affairs Blog. The articleAdvancing Health Equity Through Value-Based Care: CMS Innovation Center Update, offers insight into progress and outlines three areas for new health equity work in 2024:

  • Safety-net provider participation in models to improve care for more beneficiaries,
  • Data collection that supports whole-person care; and
  • Payment innovations to narrow disparities.

The Innovation Center authors explain how learning from initial efforts to embed health equity into model design will ultimately improve the delivery of whole-person care through permanent Medicare and Medicaid programs where appropriate, strengthen communication between care teams and beneficiaries, and improve quality.

Prescription: Reform Medicare Physician Payments. A recent article from The Heritage Foundation recommends ways Congress can reform Medicare physician payments. The article states that Congress should look beyond Medicare’s Merit-Based Incentive Program (MIPS) and make advanced Alternative Payment Models (APMs) more attractive for clinicians.

Upcoming Events

Congressional Briefing. “Alternative Payment Models – the Cure for Our Fragmented Delivery System” will be held on Capitol Hill, on Wednesday, June 26 from 12:00 pm to 1:00 pm. This event will dive into alternative payment models (APMs) and their value in improving patient care, driving savings in Medicare, and lowering healthcare costs. Experts will discuss real-world examples of successful APMs and what can be learned from them for future models. The briefing will include lessons learned and recommendations for expanding APM participation through physician payment policy.

Speakers include:

  • John Barkett, Managing Director, The Berkeley Research Group
  • Brendan Fulmer, Vice President, CareBridge
  • Melanie Matthews, President, PSW
  • Dr. Clive Fields, Co-founder and Chief Medical Officer, VillageMD
  • Dr. Farhad Modarai, Chief Clinical Officer, Strive Health

 Register here.

Double Click on Accountable Care. Save the date for upcoming in-person meetings in Washington, DC for policy-focused audiences. Details to follow.

Tuesday, September 10, 2024 – Register here
Thursday, December 12, 2024 – Register here

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