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.
CMS: (5/25) – CMS announced it has approved requests from California, Florida, Kentucky, and Oregon to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage to 12 months postpartum. CMS projects the expansions will provide coverage for an additional 126,000 families across the four states, annually.
GAO: (5/26) – U.S. Government Accountability Office (GAO), announced the appointment of five new members to the Medicare Payment Advisory Commission (MedPAC). The newly appointed members, whose terms begin in May 2022 and will expire in April 2025, are: Robert Cherry, MD, MS, Chief Medical and Quality Officer at UCLA Health; Kenny Kan, Vice President and Chief Actuary of Horizon Blue Cross Blue Shield; Gregory Poulsen, Senior Vice President at Intermountain Healthcare; and Scott Sarran, MD, Chief Medical Officer at MoreCare . In addition, Cheryl L. Damberg, PhD, Director of the RAND Center of Excellence on Health System Performance, was newly appointed to serve out the remaining term of Jonathan Perlin (who recently resigned), which will expire in 2024.
CMS: (5/27) – CMS released a report that recommends cost savings from lower-than-expected Medicare Part B spending be passed along to people with Medicare Part B coverage in the calculation of the 2023 Part B premium. HHS press release
Sen. Smith (D-MS): (5/25) – Sens. Smith (D-MN) and Moran (R-KS) introduced the Improving Access to Behavioral Health Integration Act (S.4306), which would support behavioral health integration into primary care practices.
Sens. Rosen (D-NV): (5/26) – Sens. Rosen (D-NV) and Wicker (R-MS) introduced the Specialty Physicians Advancing Rural Care (SPARC) Act (S.4330), which would authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians.
Rep. Axne (D - IA): (5/26) – Rep. Axne (D-IA) sent a letter to the CEOs of Trinity Health and MercyOne health systems following news that Trinity Health will acquire the facilities and assets of Iowa-based Mercy One Health System. The letter encourages the health care providers to use any cost savings to lower patient costs and invest in patient care. The transaction is expected to be completed summer 2022.
Aledade: (5/30) – Aledade's CEO and co-founder, Farzad Mostashari, joined the CEO of the Los Angeles County Medical Association, Gustavo Friedricherson, to share the story of Aledade's mission, commitment to empowering primary care physicians in California and across the country, and how Aledade Care Solutions is breaking new ground in patient care.
RevCycle Intelligence: (5/31) – Physician practices are on the road to post-pandemic recovery in 2021, as physician compensation and productivity is rising again, the Medical Group Management Association (MGMA) recently reported. The findings are from MGMA’s annual Provider Compensation and Production Report, which examines data from more than 192,000 physicians and non-physician providers in over 7,700 organizations.
RevCycle Intelligence: (5/25) – Prior authorization continues to increase administrative burden for physicians and impede continuity of patient care as health plans are not following their commitment to advance prior authorization reform, a study from the American Medical Association (AMA) found. In January 2018, AMA, the American Hospital Association (AHA), AHIP, American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA), and MGMA signed a consensus statement agreeing to improve prior authorization processes. The statement outlined five prior authorization reforms that promote safe, timely, and affordable access to evidence-based care for patients. Reforms also endorsed enhanced efficiency and reduced administrative burdens.
Modern Healthcare: (5/31) – Advocate Aurora Health plans to merge with Atrium Health to form an estimated $27 billion system with 67 hospitals and 145,000 employees across the Midwest and Southeast. Executives at the not-for-profit health systems claim they need a national network to compete in today's healthcare environment. But the proposed combination has raised questions about the benefits of scale, the effects of hospital consolidation on prices and which system's leaders will set strategy, industry observers said.
Patient Engagement Hit: (5/31) – The rideshare company, Lyft, first known for its app-based transportation solutions, has shifted gears to address non-emergency medical transportation benefits. In a healthcare industry increasingly embracing risk-based reimbursement contracts, while also grappling with a complex web of social needs affecting health outcomes, Buck Poropatich, the head of Lyft Healthcare, argued that investment in seamless non-emergency medical transportation is essential.“If the goal of your organization is to improve health outcomes, to not invest in transportation you're saying one of two things: either the population that I serve does not have transportation insecurity, just doesn't exist within that population; or getting to the service that your provider is not definitively promoting better health,” he contended.
Healthpayer Intelligence: (5/31) – The Centers for Medicare and Medicaid Innovation Center (CMMI) has prioritized social determinants of health and health equity for years by designing healthcare payment and service delivery models that focus on social needs and social risk adjustment. During Xtelligent Healthcare Media’s Social Determinants of Health Summit, Tequila Terry, group director of state innovation and prevention and population health at CMMI, shared how the center continues to address health equity through its Strategy Refresh and Accountable Health Communities model.
HealthAffairs Forefront: (5/31) – One Innovation Center pilot is operating in Maryland today, known as the Maryland Total Cost of Care Model (TCCM). The TCCM entails all-payer (both commercial and government) rate regulation, with hospitals operating under a prospective budget. Many have wondered whether other states can emulate this model. However, key details of the Maryland model and experience must be taken into consideration when making this determination. Perhaps most importantly, the Maryland approach has grown up slowly. Indeed, its evolution is so distinct from the rest of the country’s experience that it is hard to see how other states could rapidly move to something similar, although individual aspects of the program could be emulated. These points deserve more airing if Maryland is really to provide a model for reform.
Fierce Healthcare: (5/30) – CVS is rolling out a virtual care service that gives consumers access to primary care, on-demand care, chronic condition management and mental health services. Eligible Aetna and CVS Caremark members will be able to use the virtual primary care service to access healthcare services on demand, whether at home or in a retail or community-based setting. Members also will have the option of being seen in person at an in-network provider, including CVS MinuteClinic locations.
AJMC: (5/28) – The organizations that can take on 2-sided risk are usually bigger and that’s not always better for health care, said Jayson Slotnik, partner, Health Policy Strategies, Inc. Organizations have to have sophisticated infrastructure to ascertain the risk, measure the risk, and understand where it's coming from and correct quickly. On one hand, that sounds great. Slotnik argues that this has been bad for health care as it has encouraged consolidation and hospital acquisition of small physician practices.
Fierce Healthcare: (5/27) – Medicare Part B beneficiaries’ premiums will be lowered in 2023 to compensate for lower-than-expected spending on Biogen’s Alzheimer’s disease drug Aduhelm, HHS Secretary Xavier Becerra announced Friday afternoon. CMS had set the 2022 Medicare Part B premium in November at $170.10 per month. That rate was a 14.5 percent increase over the prior year’s $148.50 and was partially attributed to the potential costs of Aduhelm.
MedCityNews: (5/26) – In MedCity Pivot’s latest podcast, Premier CEO Mike Akire explains why he believes more provider consolidation is necessary to achieve parity with payers. Alkire talked about the importance of health systems achieving scale such that they are in a better position vis-a-vis payers who are typically much larger.
Healthcare Finance News: (5/25) – Almost half the respondents to a new survey, 44 percent, say they have avoided getting healthcare services because they were unsure of the costs. The findings, published in HeathSparq's 2022 Annual Consumer Sentiment Benchmark, show a steep increase from just one year ago, when 25 percent of patients reported skipping care. The impact of healthcare costs was a key theme of the findings. Two-thirds of respondents, for example, reported being unaware of new government regulations requiring that health insurance plans must offer price transparency to their members. Despite this low awareness, 81 percent expressed support for the rule.