The Government Shutdown Approaches Week Five. While both parties have remained entrenched in their positions, reports indicate that bipartisan talks have begun in the Senate. Some of the options being discussed include passing the original government funding bill advanced by the House, which would extend government funding until November 21. Lawmakers may also consider including funding bills for the Departments of Labor, Health and Human Services, and Education, along with another short-term funding bill with an end date in December or January. Outside pressure is mounting on lawmakers to reach an agreement amid the funding lapse for the Supplemental Nutrition Assistance Program (SNAP). As Open Enrollment begins, some consumers will also see premium increases. A4H will continue to monitor the government funding and ACA enhanced subsidy debates and will provide updates as they become available.

Increasing Advocacy and Attention to Skin Substitutes Crisis in Traditional Medicare. A4H has continued meeting with lawmakers on Capitol Hill to shine a light on the skin substitutes crisis. Various new resources are available to support stakeholders in their outreach to federal policymakers to support action on this issue:

• A4H Skin Substitutes Resource Center containing patient stories, data, and a call to action to finalize the Physician Fee Schedule proposal and provide relief for accountable care providers. A4H also launched a digital ad campaign to increase awareness of these resources in Washington, DC.
• Paragon Health Institute supported CMS’ plan to reform how Original Medicare pays for skin substitutes in its newsletter.
• New Data from the National Association of ACOs projecting 2025 skin substitutes spending to skyrocket to over $15 billion, up from $250 million in 2019.
• Articles in MedPage Today and Axios highlight this policy issue and patient impacts, including highlighting the story of a Texas woman with over $10 million in skin substitute claims, who died after about a month of intense skin procedures.

Paragon Outlines Key CMMI Reforms. In another recent newsletter, Paragon discussed a new brief by the think tank’s Jackson Hammond titled “How to Reform the CMS Innovation Center with a Choice and Competition Approach.” In Hammond’s analysis, CMMI’s past failures stem from voluntary models that reward participation rather than savings, making it difficult to determine which models were successful. Hammond identifies five key reforms to ensure CMMI reaches its potential: design demonstrations to truly test whether a given policy saves money or improves care quality; limit models in size, scope, and duration; prioritize mandatory models that better reflect real-world behavior and limit favorable self-selection; end models that fail to deliver savings; and default to market-based approaches for models that strengthen choice and competition.

Accountable for Health Institute and West Health Policy Center Convening, Dec 9. Please join us for an in-person event that will bring together industry experts, stakeholders, and government leaders who will take a closer look at ways to strengthen accountable care for an aging population. The convening will be held at the Marriott Marquis in Washington, DC.