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This Week in Physician-Led Care

October 22 to October 28, 2020

Welcome to this week's edition of the 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. 

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Administrative Updates

HHS: (10/22) – HHS announced the latest Provider Relief Fund (PRF) application period has been expanded to include provider applicants such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received Provider Relief Fund distributions. In addition, HHS will no longer define the revenue providers have lost during the pandemic by simply comparing how much they earned in 2019 to 2020 when looking at provider relief reporting requirements.

HHS: (10/22) – HHS released the 2019 Year in Review report, which summarizes the research activities and outcomes funded by the AHRQ Digital Healthcare Research Program in 2019. In 2019, the program supported 120 research grants and seven contracts that represent a total investment of $150 million. This includes $43 million in grants and contracts to improve patient engagement and shared decision making, $71 million to support clinicians’ decision making, and $36 million to improve the delivery of healthcare at the systems level.

HHS: (10/19) – CMS released a report showing the trend of lower premiums and increased issuer participation for will continue for the 2021 year. The average premium for the second lowest cost silver plan (also called the benchmark plan) dropped by 2 percent for the 2021 coverage year and, when looking at states that are using in both 2020 and 2021, 22 more issuers will offer coverage in 2021, for a total of 181 issuers.

Legislative Updates

Rep. Emmer: (10/20) – Reps. Emmer (D-MN), Hagedorn (D-MN) and Stauber (D-MN) led members of the Minnesota congressional delegation in a letter to HHS Secretary Azar expressing concern over the recently released Provider Relief Fund (PRF) reporting requirements, which change how health care providers document lost revenue as a result of the COVID-19 pandemic.

Sen. Warren: (10/20) – Sens. Warren (D-MA) and Murphy (D-CT) led 14 Senators in a letter to HHS Secretary Azar and Department of the Treasury Mnuchin urging HHS and the Department of the Treasury to conduct an analysis of how the repeal of the Affordable Care Act (ACA) in California v. Texas would affect health care coverage in the United States, particularly during the COVID-19 pandemic.

Member News

AJMC: (10/27) - Dr. Patricia Salber of The Doctor Weighs in interviewed Aledade co-founder and CEO Farzad Mostashari in the latest episode of Managed Care Cast about how his company is keeping physicians independent through value-based care.

Aledade: (10/22) - Aledade published a case study highlighting results from a pilot program launched in partnership with Surescripts. The pilot program helped spot gaps in care and prioritize effective patient interventions with the Surescripts’ Medication History for Populations.

Health Care Innovation Group: (10/22) - This month, MGMA conducted research including over 800 applicable responses around CMS’ talk of mandated participation in value-based care initiatives. According to the MGMA State Poll, 76 percent of health care leaders voiced opposition to the government requiring participation in APMs.

MGMA: (10/21) – In this episode of MGMA’s podcast series, Keith Ferandez MD, Chief Clinical Officer and Mauren Clancy, SVP Operations at Privia Health explore how technology, information at the point of care, and robust engagement can make managing complex administrative burden in value-based financial and quality performance contracts in small practices possible.

Medical Economics: (10/21) – MGMA recently held its 2020 Medical Practice Excellence conference. During a session on the second day of the conference, representatives from practices using value-based payment contracts discussed the benefits of entering into such contracts. 

Aledade: (10/20) - Aledade published an article around how the future of health care reimbursement hinges on the aligned incentives and actionable data of value-based care. CEO Farzad Mostashari noted the willingness he has observed among payers and providers to embrace this transition to help practices stay independent throughout the pandemic.

News Clips

Modern Healthcare: (10/27) - CMS Administrator Seema Verma wrote an op-ed on the potential for value-based care to be the solution for containing cost growth and ensuring access to care. For the health care system to fully transition to VBC, important policy adjustments are needed to correct its course.

AZ Big Media: (10/26) - MeMD, a national telehealth provider, recently released a white paper to highlight virtual primary care as the newest and most important evolution in telehealth. The paper looks at research and expert insights into the role of virtual primary care post-COVID.

Medical Economics: (10/23) - Many patients are putting off primary care visits due to fear of contracting the COVID-19 virus - nearly one in two adults have cancelled or postponed an in-person visit since March. Primary care physicians are transforming their practice models to continue providing quality care and navigate the current environment.

Fierce Healthcare: (10/22) - According to a report by AAMC, physician shortages are projected to grow to between 54,100 and 139,000 physicians by 2033, including shortfalls in both primary and specialty care. The demand for physicians will continue to grow faster than supply, which could have both short- and long-term impacts on the physician workforce.

Avalere: (10/22) - A new analysis reveals Medicare beneficiaries are more likely to receive Part D autoimmune drugs and less likely to receive Part B autoimmune drugs from providers that are part of ACOs compared to non-ACO providers.

Medical Economics: (10/22) - According to the AMA, the number of employed physicians now outnumber private practice physicians. As hospitals continue to consolidate, it brings into question the future of the physicians in independent practices.

AJMC: (10/22) - This article outlines how value-based contracts between managed health care systems and school districts engaged in capitated special education can help achieve better patient outcomes and lower costs for the pediatric population.

Inside Health Policy: (10/22) - HHS reversed requirements in the Provider Relief fund that required providers to define lost revenues during the pandemic by comparing how much they earned from 2019 to 2020. This decision follows push back from providers and hospitals worried the measure could force them to return relief funding.

Health Affairs: (10/21) - COVID-19 has highlighted the risk of returning to “business as usual” in health care in the future, especially as providers face financial strain from lost revenue. To avoid delivering and paying for low value care, this article presents four opportunities to leverage COVID-19 learnings to improve value in health post-pandemic.

Health Affairs: (10/21) - Several investments have been made to address the spread and impact of the COVID-19 virus, but questions have been raised over whether all such investments are cost-effective and could lead to a more economically vulnerable position. This article explores the role of value assessments in identifying ways to address the pandemic and prepare for future crises.

MedCity News: (10/21) - COVID-19 has presented an opportunity to reinvent health care delivery, leveraging technology as a way to do so. Reimbursement for innovative services and technologies, however, must support the continued emphasis on shifting to a value-based health care system.

Healthcare Innovation: (10/20) - Humana CMO Dr. William Shrank offered insight from the health plan’s 2020 Value-based Care Report, highlighting how plans are continuing to collaborate with providers to focus on shared aligned priorities and achieve better care at lower costs.





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