House and Senate Return Ahead of End-of-Month Funding Deadline. With both chambers back in D.C., all eyes will be on government funding negotiations ahead of the end of the fiscal year on September 30th. With a full-year appropriations deal unlikely, most lawmakers seem to be looking for agreement on a short-term funding bill to avoid a shutdown. Several health extenders and authorizations also expire at the end of September, including Medicare telehealth flexibilities, funding for Community Health Centers, and a delay of Medicaid Disproportionate Share Hospital cuts. A4H continues to monitor for inclusion of these and any other items impacting accountable care in government funding conversations.

Secretary Kennedy Testifies Before the Senate. The Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr, testified before the Senate Finance Committee this week. While much of the discussion focused on vaccines and the Centers for Disease Control and Prevention, Senators also raised questions around the new rural health transformation program, chronic disease, pharmacy benefit managers (PBMs), interoperability, and transparency. A memo on the hearing can be found here.

MSSP ACOs Generate Record Savings in 2024. CMS released new data on the savings generated by ACOs in the Medicare Shared Savings Program (MSSP) last week, highlighting a record high of $6.5 billion in savings in traditional Medicare for 2024 (about $13 billion after taking into account spillover effects in MA). ACOs participating in two-sided risk arrangements accounted for 82 percent of savings. These results underscore the importance and efficacy of ACOs, demonstrating the savings potential of two-sided risk arrangements and the growth in savings over time. A4H will continue to advocate for strong and clear incentives for participation in accountable care with policymakers in Congress and the Trump Administration, highlighting the growing body of evidence that ACOs drive savings and increase quality and care coordination. See A4H’s statement on the MSSP results here.

CMMI Announces Changes to the AHEAD Model, Including Incorporating Geographic Direct Contracting Elements. In an Innovation Insight post, the CMS Innovation Center (CMMI) announced new policy and operational changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model. Additionally, States must now adopt measures to promote choice and competition, develop a new prevention-focused population health plan, and meet transparency and investment requirements. The announcement also references risk-bearing geographic entities with additional tools and enhanced flexibilities to improve health outcomes and lower spending in two-sided risk, indicating a possible combination of elements of the Geographic Direct Contracting model (a model introduced in the first Trump Administration but never implemented) with AHEAD. A4H will continue to seek clarity on additional changes CMMI announces regarding the model. 

Administration Signals Priorities in New Unified Regulatory Agenda. This week, the Trump Administration released its list of expected regulatory actions for the next two years, including rulemaking already in process and anticipated future rules. CMS plans for a busy fall with several rules on the horizon, including two Innovation Center payment models expected in October and November of this year (though no further detail on the models was given), a final rule affecting the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model (readers will remember the Administration announced its intent to terminate this model), and updates to interoperability and transparency policies, among other rules. The full list can be viewed here.

HHS to Direct More Resources to Enforce Against Healthcare Information Blocking. This week, the Department of Health and Human Services (HHS) announced that it would allocate additional resources to increase enforcement against healthcare entities that restrict or block patient access, and the use and exchange of, electronic health information. HHS reaffirmed that addressing information blocking is a key priority of the Trump Administration, in line with the Make America Healthy Again (MAHA) goal of enabling patients to play a more active role in their own health care process. HHS encouraged patients, innovators, and other stakeholders who have experienced or observed information blocking to report it through the agency’s dedicated portal. Entities found to be committing information blocking could be subject to disincentives, civil monetary penalties, and certification terminations, as applicable.

CMS released its first evaluation of the Enhancing Oncology Model (EOM). Forty-four oncology practices participated, most with prior experience in value-based cancer care. The evaluation shows practices adopted strategies to lower systemic cancer drug spending—such as alternative dosing and oncology-specific urgent care—to reduce avoidable costs. Medicare payments for cancer therapy episodes declined by an estimated $13.1 million. A link to the evaluation is available here.

Amy Gleason Publishes Op-Ed in LA Times. Department of Government Efficiency (DOGE) head and CMS advisor Amy Gleason recently published an op-ed in the Los Angeles Times on her personal experience with advanced health technology and the future of the field. Gleason discussed CMS’s focus on incentivizing health tech innovation in the private sector and the agency’s ongoing work with DOGE to create a national provider directory. She called for continued partnership with the private sector to “kill the clipboard” and advance tools to turn raw data into actionable information to aid daily decision-making. Gleason will be speaking at A4H’s member-only call on Thursday, September 11.

Paragon Health Institute: “Defending WISeR.” This week, Paragon Health Institute (PHI) featured a defense of the Wasteful and Inappropriate Service Reduction (WISeR) model in their newsletter, authored by PHI President Brian Blase. Blase lauded the WISeR model as an example of “what the Innovation Center should be doing—a demonstration of reforms that are likely to both improve outcomes and lower costs in Medicare,” and detailed the potential savings, patient safeguards, and he also highlighted the rise in spending on, and potential abuse of, skin substitutes, an issue A4H has been working to address with CMS (see A4H’s recent issue brief on fixing skin substitute payments in Medicare, here).

Congressional Briefing on Kidney Care, October 21. Join A4H and C-TAC for a discussion with experts in health care, policy, and patient advocacy for a briefing on Improving Care for Patients with Kidney disease. The meeting will take place at the Rayburn Office Building, Room 2060 from 12pm to 1pm. Register here.