The House and Senate will be in session next week before departing for the Thanksgiving Holiday.

Lame Duck Session Begins. Lawmakers returned to DC this week to kick off the post-election “Lame Duck” session. Much of the week was dedicated to internal organizing as Republicans prepared for majorities in the House and Senate in the 119th Congress. Senate Republicans elected John Thune (R-SD) as the next Majority Leader. Notably, Senator Thune participates in the bipartisan Medicare Payment Reform Working Group looking at updates to the physician fee schedule and MACRA. Congress still needs to contend with funding the government this year, as well as addressing several expiring provisions and reauthorizations, including the expiration of popular COVID-era telehealth flexibilities, extending advanced Alternative Payment Model (APM) bonuses, and addressing the 2025 Medicare physician pay cut. It remains to be seen whether Congress will reach a funding agreement or if they will choose to pass a short-term stopgap funding bill into the new year. Both scenarios provide an opportunity for broader healthcare provisions to be included. A4H continues to engage with lawmakers, to push them to mitigate cuts this year, and consider additional actions to strengthen accountable care as Congress looks to 2025.

MedPAC Discusses APM Bonus for Clinicians. During MedPAC’s November Public Meeting, Commissioners discussed the expiring advanced APM bonus payments. Staff presented updated data and proposed two approaches to restructuring the bonus: calculating the bonus as a share of clinicians’ Advanced APM payments as opposed to all Part B payments; or calculating the bonus as a flat payment for each beneficiary attributed to a clinician through an APM. Reform will likely be discussed again at a later MedPAC meeting, and a recommendation may be included in a future report from the Commission. A4H has advanced an approach in line with the second option, creating a flat, attribution-based bonus that would reward broader participation in APMs, in line with goals to expand participation in models and invest in primary care. We expect this restructuring conversation to continue in the next Congress as part of broader physician payment reform efforts.

Trump Administration and Accountable Care. President-Elect Donald Trump indicated his intent to nominate Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services. In an interview in early November, Kennedy identified three priorities, removing corruption and conflicts from regulatory agencies, returning agencies to evidence-based science and medicine, and ending the chronic disease epidemic. During his first administration, President Trump, through the Centers for Medicare and Medicaid Services (CMS) and the Innovation Center, prioritized promoting value-based care by encouraging financial accountability, improved care coordination, and provider flexibility. His administration rolled out the Primary Care First, Direct Contracting, including early designs of a geographic risk model, and kidney models, which provided differing levels of financial risk to encourage accountability for cost and health outcomes. Increasing competition through transparency was another key tenet of the first Trump administration health care agenda. A4H anticipates that these key agenda items could resurface and we continue to monitor for additional health appointment announcements.

ACO REACH Participants Deliver Better Quality, Lower Cost. The CMS Innovation Center posted the participant-level financial and quality results for the ACO Realizing Equity, Access and Community Health (REACH) model for 2023. 132 REACH ACOs participated in the model, intended to improve health outcomes for Medicare beneficiaries by aligning financial incentives. The results show that ACO REACH participants improved quality and generated $1.643 billion in gross savings, with net savings for CMS of $694 million. The High Needs population ACOs, serving beneficiaries with complex care needs, achieved a higher net savings rate as compared to Standard participants. In light of these model successes and the unique features available through ACO REACH, A4H is urging model continuity beyond 2026. Our issue brief on the topic of ACO model differentiation and continuity is available here.

Medicare Physician Fee Schedule Finalizes 2.93 Percent Pay Cut, Updates to MSSP. CMS published the final CY25 Medicare Physician Fee Schedule (MPFS). The rule finalized a 2.93 percent cut to the Medicare physician reimbursement rate and includes policies to extend some telehealth services and provide for reimbursement for certain prescription digital therapeutics. CMS also finalized new Merit-based Incentive Payment System (MIPS) Value Pathways beginning in 2025; policies to mitigate the impact of significant, anomalous, and highly suspect billing activity in Medicare Shared Savings Program (MSSP) ACOs for CY24 and future years; and a mechanism through which certain ACOs can receive prepaid shared savings. CMS did not advance a new full risk or global risk option within MSSP. The agency finalized new Advanced Primary Care Management (APCM) codes, despite stakeholder comments that this approach could undermine ACO participation. A4H looks forward to working with CMS and the Administration to advance policies that bolster effective accountable care.

Accountable Health Communities Model Evaluation Shows Reduced Expenditures, Improved Care. CMS published the third evaluation report for the Accountable Health Communities (AHC) Model, covering performance in 2018-2023. The AHC Model tested whether connecting Medicare and Medicaid beneficiaries with resources to support health-related social needs (HRSNs) improved care and reduced costs. The model focused on five core HRSNs: housing, transportation, food, utilities, and interpersonal violence. CMS’ evaluation shows that the model improved the quality of care, as measured by reductions in inpatient stays and emergency department visits. Overall, CMS found that the AHC Model created significant savings, reducing health care expenditures by 3 percent for Medicaid and 4 percent for Medicare beneficiaries, and improved the quality of care.

Oncology Care Model Supplemental Report Finds Two-Sided Risk Arrangements Drove Savings. CMS published a supplemental evaluation report for the Oncology Care Model (OCM), examining how risk arrangement was related to participant performance. The report finds that participating practices engaged in a two-sided risk arrangement were the primary driver of OCM payment reductions, earned the highest performance-based payments (PBPs), and were most likely to attain quality thresholds necessary to keep the PBPs. OCM spanned 11 six-month performance periods (PPs) and was designed to test whether practices could improve cancer care and lower costs with appropriate financial incentives through an episode-based payment model. The supplemental report finds that practices engaged in two-sided risk achieved net savings for Medicare, totaling about $230 million

A4H Double Click on Accountable Care. Join us on December 12 at the Kaiser Center for Total Health (700 2nd St, NE, Washington, DC) for our next Double Click event. This event will feature sessions on the 2025 accountable care agenda, including quality measurement, legislation impacting individuals dually eligible for Medicare and Medicaid, and the future of alternative payment models and the CMS Innovation Center. Register here.

Speakers include:

• Mara McDermott, CEO, Accountable for Health
• Josh Trent, Managing Principal, Leavitt Partners
• Joe Albanese, Senior Policy Analyst, Paragon Health Institute

Save the Date A4H @ Health Care Value Week. Join A4H on February 25 for an in-person event in Washington, DC, in conjunction with Health Care Value Week. The event will bring together organizations, stakeholders, and policymakers to discuss accountable care successes and the work ahead. Sessions will include Congressional, community, and provider perspectives on accountable care and the outlook for the future of healthcare delivery reform. Register here.