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:

  • Discussed the new Accountable Care Organization (ACO) Primary Care Flex model with the CMS Innovation Center team.
  • Met with Rep. Kim Schrier, M.D. (D-WA) to discuss accountable care educational efforts on Capitol Hill.
  • Met with the Co-Chairs of the House Innovation Caucus, Reps. Ami Bera (D-CA), Mike Kelly (R-PA), Suzan DelBene (D-WA), and Neal Dunn (R-FL) to discuss ways to build on the recently passed extension of the advanced alternative payment model (APM) bonus.
  • Attended the Value Transformation Roundtable with the Centers for Medicare & Medicaid Services (CMS), the Innovation Center, and stakeholder groups to discuss recently announced models, stakeholder engagement efforts and communications about accountable care.

Save the Date for our next Double Click on Accountable Care – May 14th, in Washington, DC. Register here.

Congressional News

The House is in recess for two weeks. Following the expected passage of the FY24 funding package, the Senate will also be in recess for two weeks.

Government Funding Deal Reached. The House passed a final package of bills to fully fund the government for fiscal year 2024, including funding for the Department of Health and Human Services, among other things. A summary is available here. As a reminder, a smaller package of funding bills was signed into law earlier in March, which included a reduction to the 2024 Medicare physician payment cut by 1.68 percent and an extension of the advanced APM incentives for one year at 1.88 percent. With funding for FY24 complete lawmakers have until September 30, to reach an agreement on FY25 levels.

HHS Secretary Becerra Testifies Before Congress. Following the release of the President’s FY25 budget earlier this month, Health and Human Services (HHS) Secretary Xavier Becerra testified before Congress on the proposed budget. This annual trip to Capitol Hill is usually the only public forum for Members of Congress to raise questions directly with the Secretary. During testimony before the Senate Finance Committee, Senator Bill Cassidy, M.D. (R-LA) highlighted recent findings of catheter fraud claims as an example of the important work ACOs do in analyzing data to ensure better care and lower costs. During the same hearing, Sen. Sheldon Whitehouse (D-RI) discussed his support for accountable care and the Centers for Medicare and Medicaid Services (CMS) Innovation Center. A4H continues to work with lawmakers to underscore the importance of accountable care in advancing high quality, low cost care.

New Legislation Focused on Improving Care for those Dually Enrolled in Medicare and Medicaid. Members of the Senate Duals Working Group introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act. The Working Group released the revised bill text following a solicitation last summer for stakeholder input. A4H submitted a letter and met with Senator Cassidy (R-LA) to provide feedback last year. We are pleased to see that several of our recommendations are reflected in the new bill text. A4H will be hosting a members only webinar on April 25 to discuss the legislative landscape for those dually enrolled in Medicare and Medicaid.

Administration

CMS Launches ACO Primary Care Flex Model. The voluntary model offers a one-time advanced shared savings payment and monthly prospective primary care payments (PPCPs) to certain low-revenue Medicare Shared Savings Program (MSSP) ACOs. The model will run for a five-year period beginning January 1, 2025. Interested organizations must apply to the Medicare Shared Savings Program to participate. A4H welcomed this new model as a positive step toward expanding access to effective accountable care across the country. At the A4H Total Cost of Care Committee meeting this week, members discussed feedback on this model as well as other components of the Medicare ACO portfolio, including ongoing work on the development of a “full risk” MSSP track and strengthening the ACO Realizing Equity, Access, and Community Health (ACO REACH). A4H will provide additional feedback to the agency about Primary Care Flex as new information becomes available.

Resources

CMS Outlines Updates to the Medicare Value-Based Care Strategy in Health Affairs. CMS and Innovation Center leaders outlined policy areas of consideration: multi-payer alignment, growth of accountable care, and promotion of equity. The blog discusses efforts to align quality measurement and delivery of claims data, measuring value-based care adoption in Medicare Advantage, new strategies to encourage specialty integration in accountable care, and improving flexibilities and incentives to address disparities and lower barriers to participation for those that provide care to underserved populations.

US of Care Webinar on AHEAD Model. The webinar on the All-Payer Health Equity Approaches and Development Model featured speakers from CMMI and state health agencies. A recording of the webinar can be found here and the slide deck from the presentation can be found here.

Duke Margolis Paper on Modernizing Medicare Risk Adjustment. The new technical paper outlines an innovative path forward for modernizing Medicare’s risk adjustment system. The paper centers on two key concepts: aligning data reporting for risk adjustment, quality, and performance reporting, and identifying more accurate sources of data for risk calibration to reflect the growth of accountable care participation.

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