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 House Energy and Commerce Committee majority staff to discuss how accountable care organizations (ACOs) can help identify waste, fraud, and abuse in federal programs. A4H addressed the importance of restitution for ACOs who help identify fraudulent behavior.
  • In advance of the House Ways and Means, Subcommittee on Health hearing on improving value-based care for patients and providers, A4H met with Committee staff to provide background information and suggested areas of questioning. A4H shared two reports highlighting models that have saved money and increased access to care (more below).
  • Participated in a Value Transformation Roundtable with other accountable care stakeholders and the Centers for Medicare and Medicaid Services (CMS) to discuss recent developments in accountable care.
  • Hosted a briefing on Capitol Hill focusing on the benefits of accountable care (more below).

Congressional News

A4H Hill Briefing on Alternative Payment Models. A4H hosted an educational Hill briefing on alternative payment models (APMs), including opening remarks from Representatives Dan Crenshaw (R-TX) and Dr. Kim Schrier (D-WA). A panel of bi-partisan former government officials and participants in APMs shared their successes with ACOs, bundled payments, and kidney models. The briefing highlighted how APMs have improved patient care and driven savings in Medicare and included patient stories contrasting fragmented fee-for-service experiences with coordinated, accountable care experiences. An event recap is available here.

House Ways and Means Health Subcommittee Hearing on Value-Based Care. During the hearing, lawmakers and the witness panel discussed Congressional oversight of the CMS Innovation Center, ways to incentivize rural provider participation in accountable care, and increasing transparency. Rep. Adrian Smith (R-NE) pointed out that Congress does not discuss value-based care often enough and commended ACO quality performance. Lawmakers were interested in understanding how to maximize the Innovation Center’s efficacy, increase model participation, and streamline incentives and quality measurement. A summary of the hearing is available here. This hearing adds to an ongoing dialogue about Medicare payment reforms and bi-partisan support for accountable care. A4H continues to work closely with the Committee as lawmakers consider short- and long-term policies that strengthen accountable care.

Administration

HHS Released Information Blocking Final Rule with Implications for Accountable Care. HHS released a final rule that establishes disincentives for health care providers who engage in information blocking, practices that the health care providers knew were unreasonable and were likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information (EHI), except as required by law or covered by a regulatory exception. Under the rule, a clinician who has engaged in information blocking will receive a zero score in the MIPS Promoting Interoperability performance category (typically a quarter of the total final score). Further, a provider in a MSSP ACO who has committed information blocking may be ineligible to participate in the program for one year. A4H is disappointed to see harsher penalties for participants in accountable care as compared to those remaining in fee-for-service, and plans continued engagement with the Administration on this issue. A4H members can learn more about our work on this and other health information technology issues by participating in our Data and Technology Committee.

CMS Announces Notice of Funding Opportunity (NOFO) Application Period for Innovation in Behavioral Health (IBH) Model. The IBH Model seeks to improve behavioral and physical health outcomes and quality for Medicare and Medicaid beneficiaries with moderate to severe behavioral health conditions and aims to integrate behavioral health with physical health care and health-related social needs. IBH is a state-based model run by state Medicaid agencies. The NOFO application for the IBH Model can be found here. CMS will host a NOFO webinar on July 11; more information on the webinar will be available soon via the IBH Listserv. The IBH Model webpage can be found here.

CMS Releases Third Evaluation of MOM Model. CMS released its third evaluation of the Maternal Opioid Misuse (MOM) Model. The model aims to improve the quality of care for pregnant and postpartum Medicaid patients with opioid use disorder. The Model is currently in seven states, and the agency released key takeaways from the evaluation, including:

  • Model enrollment increased but remained below projected levels due to systemic barriers to participation.
  • Peer recovery services emerged as a promising practice based on participant interviews.
  • Care delivery partners developed service capacity, though sustainable payment mechanisms remain an issue.

CMS stated that next year’s evaluation will examine costs and patient outcomes.

Innovation Center Announces In-Person Sessions to Discuss Rural Health. The series of in-person meetings will create opportunities discuss ideas to address rural health challenges and potential solutions. Through these “Rural Health Hackathons,” the Innovation Center hopes to work with stakeholders to identify actions to improve clinical outcomes and increase access to care in rural settings. CMMI will subsequently release a report on the ideas generated from these meetings.

Resources

Supreme Court Ruling Ends Chevron Deference. This morning, the Supreme Court announced that it will overturn the decades-long legal precedent that empowered federal agencies to use discretion in issuing regulations when an aspect of federal law is determined to be ambiguous. The ruling will have significant implications for federal rulemaking, including regulations issued by the Department of Health and Human Services. It is also expected to impact Congressional activity, likely resulting in a demand for more specificity in legislation.

Upcoming Events

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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