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 the House Budget Committee to discuss the CMS Innovation Center and efforts to enhance accountable care models, including a letter to the Government Accountability Office (GAO) regarding the CMS Innovation Center (discussed below).
  • Met with members of the GOP Doctors Caucus to discuss physician payment reforms and ways to advance accountable care.
  • Hosted an educational call for our Voices of Accountable Care Committee regarding the new proposed mandatory bundled payment model, Transforming Episode Accountability Model (TEAM).
  • Joined national health care organizations in a letter to the Centers for Medicare and Medicaid Services (CMS) requesting that accountable care organizations are held harmless from anomalous Medicare spending outside of their control related to catheter billing.
  • Met with Department of Health and Human Services, Counselor to the Secretary Lynn Sha to discuss successes in accountable kidney care and suggested model improvements.

Register for the Double Click on Accountable Care – May 14th, in Washington, DC. Agenda now available.

Congressional News

The House and Senate are both scheduled to be in session next week.

House Budget Committee GOP Requests Information on CMS Innovation Center Models From GAO. House Budget Committee Chairman Jodey Arrington (R-TX) and Budget Committee Health Care Task Force (HCTF) lead Rep. Michael Burgess, M.D. (R-TX) sent a letter to the U.S. Government Accountability Office (GAO) requesting an update on CMS Innovation Center (CMMI) performance and use of funds. The lawmakers asked GAO for an assessment of which models saved money, how CMMI incorporates the Physician Focused Payment Model Technical Advisory Committee (PTAC) recommendations, how CMMI forecasts model savings, and the impact Retroactive Trend Adjustments have on model participation. The letter comes as lawmakers signal a renewed interest in CMMI and potential policy changes. A4H is working closely with Congress to highlight how accountable care has produced savings and better health outcomes, and to ensure that policy continues to drive toward the goal of expanding effective accountable care.

Congress Holds Hearings on Change Healthcare Cyberattack. UnitedHealth Group (UHG) CEO, Andrew Witty testified this week on the cyberattack and UHG response. During the hearings lawmakers raised concerns on the impact on providers who have had to absorb costs themselves or who have incurred greater administrative costs because of claims processing issues. Mr. Witty discussed UHG’s interest-free loan program and encouraged Members of Congress to connect UHG with any provider groups or patients who still need help. While the focus of these hearings was the cyberattack, lawmakers took the opportunity to raise concerns around prior authorization, role of pharmacy benefit managers (PBMs), and broader consolidation in the health sector.

Administration

CMS Publishes Update on National Quality Strategy. The publication, Quality in Motion: Acting on the CMS National Quality Strategy, outlines the ways the Centers for Medicare and Medicaid Services (CMS) has implemented components of the National Quality Strategy (NQS) since it was launched in 2022, building on the agency’s efforts to improve health care quality and the continuum of care through all avenues, including value-based payment programs.

Resources

ACO Primary Care Flex Model Analysis. The article, “Can ACOs Flex While Supporting Specialty Care?” focuses on implementation of the recently announced ACO Primary Care Flex Model, which allows participation by low-revenue Medicare Shared Savings Program ACOs only. The analysis, authored by A4H member Premier, Inc., highlights the differences in performance between high and low revenue ACOs, making the case that all types of organizations, and the people they provide health care services, can benefit from hybrid and population-based payment models.

Reforming Medicare Risk Scores. The article, “Inferred Risk: Reforming Medicare Risk Scores to Create a Fair System”, proposes that Medicare should pilot a data-driven, inference-based approach to establishing patient risk scores in MA and Accountable Care Organization (ACO) programs. Abe Sutton, co-founder of A4H member Honest Medical Group, highlights how inferred risk can improve accuracy and fairness, reduce gaming, and minimize administrative spend.

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