News Clips
Health Affairs: (6/7) – In a response to other industry leaders, Rick Gilfilan and Don Berwick reiterate their criticisms of Medicare Advantage and the ACO REACH programs. While supportive of the continuation of CMS alternative payment model efforts through the CMS Innovation Center and in conjunction with CMS programs such as the Medicare Shared Savings Program, they believe that the best pathway is for CMS to develop an advanced ACO track with total cost of care capitation with providers.
Fierce Healthcare: (6/7) – Providers are urging the Biden administration to make a drastic overhaul of a radiation oncology payment model if the agency decides to bring back the oft-delayed experiment. Comments were due Tuesday on a Centers for Medicare & Medicaid Services (CMS) proposed rule that indefinitely delays the model, which already had its start date delayed to 2023 by Congress. The model was created to reimburse oncology practices and outpatient hospital sites for total episodes of care. The mandatory model would also make site-neutral payments for specific radiation therapies. But the model has generated major industry and congressional pushback since its announcement. Various provider groups charged that the model masqueraded as a pay cut to oncology practices and hospitals.
Fierce Healthcare: (6/3) – Many states and payers contract with managed behavioral health care organizations, effectively carving out those services from physical health. Plans like Blue Cross North Carolina have added behavioral health as a benefit, aiming for most of its network primary care practices to deliver integrated care by the end of this year. Taking on additional risk in a value-based care model is another way to improve access and outcomes.
NEJM: (6/2) – Implementing value-based care must include reducing disparities in care and ensuring equity. To reduce disparities, we must first understand where and why they occur. The authors detail Blue Cross’ methodology for quantifying health equity in its commercially insured population, report the results of the insurer’s disparities analysis, and describe a plan to incorporate health equity into current and future value programs.
Healthcare Innovation: (6/2) – To combat the possibility of patient profiling in value-based care, CMS recently redesigned the ACO model to better reflect the agency’s vision of creating a health system that achieves equitable outcomes. The new model, known as the ACO Realizing Equity, Access, and Community Health (REACH) model, is a redesign of the Global and Professional Direct Contracting (GPDC) model and incorporates stakeholder feedback, participant experience, and Biden Administration priorities, including the commitment to advancing health equity in the ACO model.
AMA: (6/1) – 120 provider organizations endorsed the American Medical Association’s (AMA) new Medicare payment reform principles. The principles provide a framework to reshape the Medicare payment system so that it works better for patients and physicians, and put an end to the annual advocacy exercise of stopping impending payment cuts. The AMA framework represents the first stage in medicine’s effort to develop and propose substantial changes to the payment system to improve the financial viability of physician practices and ease its administrative burdens. AMA lists five principles on promoting value-based care, including: reward the value of care provided to patients; encourage innovation; offer a variety of payment models and incentives tailored to the distinct characteristics of different specialties and practice settings; provide timely, actionable data; and recognize the value of clinical data registries.
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