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 Senate Finance Committee Minority staff to discuss the Committee’s recent White Paper on physician payment reform.
  • Convened A4H Total Cost of Care Committee to discuss A4H’s response to the Senate Finance Committee physician payment reform request. Feedback is due to the Committee by June 14.
  • Hosted the Voices of Accountable Care Committee to discuss beneficiary considerations for the Transforming Episode Accountability Model (TEAM) mandatory bundled payment model proposal.
  • Submitted comments in response to the Centers for Medicare and Medicaid Services (CMS), Request for Information (RFI) on Medicare Advantage (MA) Data, encouraging the agency to accelerate the adoption of accountable care and include MA in its 2030 accountable care goals.

Congressional News

Both the House and Senate will be in session for the next two weeks.

Congressional Landscape: Physician Payment Reform. Several expiring programs and reauthorizations will likely serve as the basis for a healthcare package that could come together after the election. The House and Senate have begun soliciting feedback on physician payment and chronic care proposals, preparing for both short- and long-term actions on these topics. In the Senate, the Finance Committee issued a White Paper with proposals and questions for stakeholder feedback. In addition, A4H recently met with a bi-partisan Senate working group focusing on physician payment proposals, including advancing alternative payment models (APMs). In the House, the GOP Doctors Caucus and key healthcare committees have begun examining proposals to advance APMs, reform the Merit-Based Incentive Payment System (MIPS), and take a closer look at the CMS Innovation Center. A4H continues to work with Congressional stakeholders to advance policies that strengthen accountable care.

Administration

CMS Now Accepting ACO Primary Care (PC) Flex Model Applications. CMS is now accepting applications for the ACO PC Flex Model. The Request for Applications (RFA) contains additional details on eligibility criteria, the payment methodology, and specifics of how the model’s Prospective Primary Care Payments can be used. CMS is hosting a webinar on the ACO PC Flex Model application on Thursday, June 6 (register here). ACO PC Flex provides an additional accountable care participation opportunity for certain low-revenue Medicare Shared Savings Program ACOs who want to test capitated payment for primary care services.

CMS Releases Evaluation of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. The evaluation found that in model year 4, participants reduced total episode payments by $930 per episode, or 3.5 percent of the baseline mean, relative to the comparison group. Changes in post-acute care use and spending drove the reduction in payments. The report finds varied results for readmission and mortality rates and varied results for patient-reported functional status, care experience, and satisfaction with care. The report also indicates that hospitals and physician group practices transformed care on four domains: creating a culture around accountable care; investing in technology and care management tools and staff; creating or improving processes around data, standardized care pathways, and connections to primary care providers; and forming new partnerships between inpatient providers and post-acute facilities. CMS notes that it made significant design changes starting with model year with the aim of driving increased savings and expanding care redesign to more patients.

CMS Announces Enhancing Oncology Model (EOM) RFA, Second Cohort Opportunity and Model Updates. The CMS Innovation Center released updates and a Request for Applications (RFA) for a second cohort for the Enhancing Oncology Model (EOM). Changes to the model, which will also apply to the current cohort beginning in January of 2025, include a two-year model extension, a higher monthly payment for enhanced services, and a higher threshold for recoupment. The EOM webpage can be found here, and the RFA is available here.

Proposed Rule on Impact of Anomalous Billing Increases on the Medicare Shared Savings Program (MSSP) Under Review. The Office of Management and Budget (OMB) is reviewing a proposed rule related to a recent spike in catheter billing. A4H recently joined national health care organizations in a letter to CMS requesting that ACOs be held harmless from anomalous Medicare spending outside of their control. A4H continues to work with its members and policymakers on this issue.

Resources

Berkeley Research Group (BRG) Paper Showcases Value-Based Care Cost Savings. The paperLowering Costs through Value-Based Care, highlights savings from certain CMS Innovation Center models and MSSP. The paper highlights that almost all ACO models and many specialty care models have saved money for Medicare. A4H has shared this report with lawmakers and their staff to inform conversations about policy directions for the CMS Innovation Center and physician payment reform.

JAMA Viewpoint Article on Value-Based Payment. The article, The Promise and Challenge of Value-Based Payment, assesses both the demonstrated successes and lingering questions about the actual benefits of value-based payment. The authors, one of whom – Dr. Amol Navathe – is Vice Chair of the Medicare Payment Advisory Commission (MedPAC), recognize successes in the Medicare Shared Savings Program, including $8 billion in net savings and improved quality performance. The paper concludes that paying for value is “without any question a wise approach” but that a more efficient method of assessing population risk and measuring value is needed.

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. 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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