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: (8/2) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a new data point assessing recent changes in health insurance coverage, finding that the uninsured rate declined throughout 2021 and early 2022 - reaching a historic low of 8 percent by the first quarter of 2022. This reflects 5.2 million people gaining coverage since the end of 2020. The report also assesses coverage changes among low-income adults in states with recent Medicaid expansions.
CMS: (8/1) - CMS unveiled guidance on a new optional Medicaid health home benefit for Medicaid-eligible children with medically complex conditions, which would help state Medicaid programs provide such children with person-centered care management, care coordination, and patient and family supports.
The White House: (7/29) - The White House announced new actions to strengthen school-based mental health services and address the youth mental health crisis. HHS is granting $80 million in awards to support pediatric primary care providers, emergency departments, and schools to rapidly access mental health specialists’ expertise and better connect children to care, and $60 million for HHS to train primary care residents in the prevention, treatment, and referral of services for mental and behavioral health conditions for pediatric and adolescents.
CMS: (7/28) - CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP for all states and D.C. These data reflect a range of indicators related to key application, eligibility, and enrollment processes within the state Medicaid and CHIP agency.
CMS: (7/28) - CMS released a Request for Information (RFI) seeking public comment on the Medicare Advantage (MA) program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable. The RFI includes several questions related to value-based care within the MA program to inform how CMS can drive innovation to promote person-centered care.
HHS: (7/27) - HHS ASPE released a report examining opportunities to improve data interoperability and integration to support value-based care. The authors conducted stakeholder interviews across 21 organizations that focused on the current state of data integration, the uses of data integration in value-based care, and the barriers to and facilitators of data integration.
HRSA: (7/27) - The Health Resources and Services Administration (HRSA) announced the availability of nearly $15 million to grow the nursing workforce, improve access to nursing education, and advance health equity.
Senate Appropriations Committee: (7/28) - The Senate Appropriations Committee released the Chairman’s mark of the 12 Senate appropriations bills, including the bill text and explanatory statement for the Departments of Labor, HHS, Education, and Related Agencies for FY2023. Notably, the bill seeks to promote the Primary Care Training and Enhancement (PCTE) program, the Primary and Behavioral Health Care Integration (PBHCI) initiative, integration of value-based care in comprehensive psychosocial rehabilitation, and Whole Child Health Models that advance pediatric value-based care models.
Senate Appropriations Committee:(7/28) - The Senate Appropriations Committee released a $21 billion emergency supplemental funding bill to provide the necessary resources to prepare for the next phase of the COVID-19 pandemic and to address other emerging diseases that pose a significant threat to public health.
Inflation Reduction Act of 2022: (7/27) - Senate Democrats unveiled the new $739 billion proposal for the FY2022 Budget Reconciliation bill, which would allow Medicare to negotiate for prescription drug prices and extend the expanded ACA credits for three years through 2025, among other provisions.
Improving Seniors’ Timely Access to Care Act: (7/27) - On July 27, the House Ways & Means Committee marked up and advanced the Improving Seniors’ Timely Access to Care Act (H.R. 3173), which would make it easier for seniors to get the care they need and improve outcomes by modernizing the prior authorization process in Medicare Advantage. The bill now goes to the full House for consideration in a fall vote. Stakeholder remarks
Rural Physician Workforce Production Act: (7/26) - Reps. O’Halleran (D-AZ) and Harshbarger (R-TN) introduced the Rural Physician Workforce Production Act of 2022 (H.R. 8508), which would support rural residency training funding that is equitable for all States. This bill is supported by several organizations, including PEPC member AAFP, as a means to address the current primary care physician shortages facing the country.
Aledade: (8/02) – Aledade and Elevance Health announced a partnership that will help enhance the consumer experience and health outcomes for those seeking services from independent primary care practices. The partnership centers on assisting independent primary care physicians across the country transition to value-based care, which is proven to improve health outcomes and lower costs for consumers.
AAFP: (7/29) – The American Academy of Family Physicians’ (AAFP) President Sterling Ransone M.D. hosted a Q&A with Cameron Webb, M.D., J.D., the White House response team’s senior policy adviser for equity, that delved into the latest developments related to the pandemic and more. The interview covered a range of topics important to family medicine, including around vaccination and COVID-19.
Aledade: (7/29) – Aledade’s Executive Vice President and CEO of Aledade Care Solutions, Mandy Cohen, spoke with Jacob Effron for the second episode of the Vital Signs podcast. During the podcast, they discussed Mandy's background in CMS and North Carolina, innovation in Medicaid, the move to risk in value-based care, and much more.
AAFP: (7/28) – In this blog, the AAFP discusses the CMS CY2023 Medicare physician fee schedule and Quality Payment Program proposed rule. AAFP notes that statutory budget-neutrality requirements and prohibitions on annual payment updates to account for inflation will, without intervention from Congress, continue to hurt primary care practices and undermine patient care. AAFP encourages others to press Congress to do the right thing for primary care and the U.S. health care system by joining their Speak Out campaign.
MGMA: (7/28) – MGMA and partner organizations sent a letter to Congress, urging action to mitigate pending Medicare cuts. Specifically, the organizations urge Congress to pass legislation that provides at least a 4.5 percent conversion factor adjustment for 2023, waives the 4 percent statutory PAYGO requirement, and provides a one-year inflationary update based on the Medicare Economic Index to provide short-term fiscal stability for providers.
The American Journal of Managed Care: (8/2) – The unique circumstances safety-net providers face must be considered when designing and adopting alternative payment models (APMs). Prospective, population-based payments that are condition-specific or defined-scope-of-practice APMs account for the nonfinancial as well as financial risks that providers face and offer providers strong revenue stability and flexibility with lower risks.
JAMA: (7/28) – Consolidation of hospital systems and physician practices over the last decade has resulted in large health care systems where physicians face challenges to advocate and meaningfully participate in organizational governance. As a result, it is likely that there will be increased discussions of physician unions as a response to conflicts between physicians and hospital leaders over governance, compensation, work rules, and strategy.
Behavioral Health Business: (7/28) – In this interview, Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, discussed how CMS is addressing social determinants of health and equity in behavioral health care and the future of behavioral health services. Notably, she mentioned a goal of CMS is to make care more effective by providing payment for the integration of behavioral health with primary care, by investing in holistic care models like ACOs.
NEJM: (7/28) – This article highlights clinical and economic opportunities for primary care practices taking on accountability for total health care spending for a defined patient population, as well as several concerns. These concerns include providers intensifying their diagnostic coding and strategically investing in their performance on specific quality measures without meaningfully improving quality or efficiency. Further, providers may face a tough balancing act between economic incentives to demonstrate savings with the fiduciary obligations to generate profits for investors. The authors outline steps policymakers and primary care leaders can take to mitigate these concerns.
Medpage Today: (7/27) – This opinion piece contemplates the question of whether hospital consolidation is inherently bad for consumers, highlighting that evidence is mixed and analyses are hampered by the inability to account for a wide range of variables. The author concludes that he is optimistic large, consolidated, non-profit hospital systems will successfully meet quality and cost expectations
Health Affairs: (7/27) – This article outlines recommendations for states and the federal government to strengthen primary care. Among key approaches for state Medicaid programs is changing how primary care providers are paid to capitated or partially capitated primary care alternative payment models. The authors recommend that the federal government provide resources and reinstate federal funding for primary care practice improvement, especially for independent and rural practices, and revisit current approaches to Medicare payments for critical access hospitals and rural health clinics, which create misaligned incentives and preclude state participation in CMMI models.
Digital Health Insights: (7/27) – Key features of CMMI’s Enhancing Oncology Model have shown promise in previous programs and are strong candidates to carry over into future value-based care models, including refining incentive opportunities to support ongoing care transformation, focusing on a smaller number of eligible care episodes, and treating health equity as a central pillar of the patient experience.
Bain & Company: (7/27) - Bain & Company released a new study entitled “Primary Care 2030: Innovative Models Transform the Landscape,” which shows that new primary care models from nontraditional players could capture as much as a third of the US primary care market by 2030. Of note, the shift from fee-for-service to value-based reimbursement models has been one of the most significant sources of innovation in primary care, a trend that is expected to accelerate. Both independent and payer-owned advanced primary care providers will continue playing a major role.
American Action Forum: (7/26) - The Federal Trade Commission (FTC) has successfully fended off four major hospital mergers since the Biden Administration took office, and is looking to take further action in this space. Health care markets with the highest concentration have the highest prices - as much as 12 percent higher in markets with a single hospital vs. those of hospitals with four or more competitors. Hospitals have also been rapidly acquiring physician practices. The FTC has signaled it will take a closer look at vertical integration, cross-market consolidation, and consolidation’s effects on the labor market, among other issues.