The House and Senate are both in session next week.

Congress Passed Legislation Extending Government Funding until September 30. The legislation provides funding roughly in line with fiscal year 2024 funding levels and extends the narrow set of health programs and provisions that were included in the December 2024 legislative package, including Medicare telehealth flexibilities, funding for Community Health Centers, and a delay of the Medicaid Disproportionate Share Hospital cuts. The legislation did not include any relief for the 2.82 percent Medicare physician fee schedule cut and did not reinstate the advanced alternative payment model (APM) bonus. At the end of 2024, key health committees negotiated and agreed on a broader health care package that included an advanced APM bonus of 3.53 percent and a Medicare physician payment fix. While those provisions still have bipartisan support, it currently seems that September funding negotiations will be the next best chance to advance these policies. A4H continues to work with Congress to advance accountable care policy and urge action on these issues.

Dr. Oz’s Confirmation Hearing Emphasizes Medicaid and Medicare Advantage Payment. Dr. Mehmet Oz, President Trump’s nominee for CMS Administrator, had his nomination hearing before the Senate Finance Committee. During the hearing, most Democrats used their allotted time to raise questions about protecting Medicaid. Dr. Oz committed to working with lawmakers to address alleged upcoding and overpayment in Medicare Advantage, emphasized the importance of preventative care and reducing health care costs, thereby progressing towards Medicare solvency, and discussed technology and the use of artificial intelligence (AI). A4H expects he will be confirmed in late March or early April. Once Dr. Oz is confirmed, we also expect to see additional information about a proactive accountable care agenda at CMS.

Democratic Physician-Lawmakers Launched Congressional Doctors Caucus. Six Democratic Members of the House of Representatives, Rep. Ami Bera (D-CA), Rep. Herb Conaway (D-NJ), Rep. Maxine Dexter (D-OR), Rep. Kelly Morrison (D-MN), Rep. Kim Schrier (D-WA), and Rep. Raul Ruiz (D-CA), launched the Congressional Doctors Caucus to promote the health and well-being of Americans, advance pragmatic health care policy, and provide insights on critical health issues. A4H looks forward to engaging with the caucus and its members on ways to improve patient outcomes, lower costs, and advance accountable care.

CMMI Will Terminate a Handful of Models Early. The CMS Innovation Center (CMMI) announced these changes following a review of the model portfolio against the Innovation Center’s statutory authority. A fact sheet on the decision states Maryland’s Total Cost of Care, ESRD Treatment Choices, Primary Care First and Making Care Primary will now end in December 2025. CMS also said it will consider reducing the size of the Integrated Care for Kids model and that it will no longer pursue the Medicare $2 Drug List and the Accelerated Clinical Evidence model (models that had been announced but not yet implemented). CMS estimates a savings of $750 million by terminating selected models. CMMI also indicated plans to announce a new strategy focused on making Americans healthier through preventative, evidence-based practices, empowering people with information, and driving choice and competition. A4H is pleased that the model termination announcement gives participants until the end of the year to plan transitions to other models. We look forward to working with the Administration on an agenda that supports primary care through ACOs and the physician fee schedule, and urging continuity for models that deliver cost savings and better health for beneficiaries.

A4H Welcomes HHS Secretary Robert F. Kennedy, Jr. A4H sent a letter to U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., congratulating him on his confirmation and emphasizing collaboration opportunities focused on accountable care. The letter highlights how accountable care is a critical tool for helping those with chronic diseases through increased care coordination and disease management. During his confirmation hearing, Secretary Kennedy emphasized the importance of value-based care and healthcare reforms’ significance in driving the system toward this transition.

NEJM: “Crossing the Chasm” to Transition to Value-Based Care. A new article co-authored by Geoffrey Moore and Farzad Mostashari, M.D. in NEJM Catalyst, Crossing the Chasm: How to Expand Adoption of Value-Based Care, considers a business perspective on how to drive adoption of value-based care, influenced by Geoffrey Moore’s book Crossing the Chasm and Dr. Mostashari’s experience in primary care. The authors draw comparisons between the adoption of electronic health records (EHR) and the future increase in the adoption of value-based care arrangements. The authors recommend CMS take a similar strategic approach to value-based care as they did with EHR adoption, noting that the agency was able to drive EHR adoption from 22 percent to 74 percent by focusing on those providers most ready for change. By focusing on primary care physicians not well served by the current fee-for-service (FFS) payment system, the authors say, CMS could guide transformation in the health care space and increase the number of providers participating in ACOs.

Save the Date for Health Care Value Week: March 2-6, 2026. Thank you to all our members and stakeholders who joined us for Health Care Value Week. We look forward to hosting virtual and in-person events again next year. Please mark your calendars, additional details to follow.