Welcome to The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
HHS: (6/2) - HHS released the annual Social Security and Medicare Trustees Reports. The Trustees Reports include extensive information about the current operations including that the Medicare Trust Fund is expected to be depleted in 2028, not 2026 as was previously estimated. Fact Sheet
CMS: (6/2) - CMS released guidance highlighting its recommended top ten fundamental actions to prepare for unwinding of the public health emergency (PHE).
CMS: (6/1) - CMS released multiple evaluation and savings reports from participating states, New York and Texas, in the Financial Alignment Initiative. This initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.
AAFP: (6/02) – AAFP’s Family Medicine Advocacy Summit, held May 22-24 in Washington, D.C., brought together more than 240 Academy members, who met with 220 members of Congress and their staffs to rally behind three top AAFP policy priorities: increasing access to telehealth, addressing the mental health crisis and finally ensuring Medicaid payment parity.
California Medical Association: (6/01) – The California Medical Association (CMA) is one of 120 organizations that have endorsed the American Medical Association’s (AMA) new Medicare payment reform principles. The principles—outlined in Characteristics of a Rational Medicare Physician Payment System—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.
Aledade: (6/01) – The State Policy Program at Aledade aims to identify, address, and rectify this issue by creating an environment where physicians and practice leadership can be actively engaged, consulted, and included in decision-making conversations that will impact their practices and the health of the patients they serve. Through increased education, awareness, and access to advocacy opportunities via physician-led policy committees, our partner practices have the chance to shape the future of primary care.
Florida Medical Association: (6/01) –Rajan Wadhawan, MD, was appointed by the Florida Speaker of the House of Representatives to serve as one of the inaugural council members the state of Florida’s Rare Disease Advisory Council (RDAC). As one of 20 representatives on Florida’s newly created RDAC, Dr. Wadhawan and his colleagues will work to improve health outcomes for those with a rare disease by making recommendations to state leaders on critical issues, including the need for increased awareness, diagnostic tools and access to affordable treatments and cures.
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.