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.
CMS: (4/1) – The first cohort of the Direct Contracting Model Professional and Global track began on April 1, 2021. Additional information on the model can be found here.
HHS: (4/1) - HHS announced new efforts to encourage vaccinations and increase vaccine confidence. HHS is launching the COVID-19 Community Corps – a nationwide, grassroots network of local voices people know and trust to encourage Americans to get vaccinated. HHS is also unveiling new social media profile frames so Americans can display their choice to get vaccinated and encourage their friends and family to do the same.
CMS: (4/1) - HHS announced additional savings and lower health care costs for consumers on HealthCare.gov under the American Rescue Plan. An average of four out of five consumers currently enrolled in a plan through HealthCare.gov will be able to find a plan for $10 or less per month with the newly expanded financial assistance under the American Rescue Plan. Additionally, after advance payments of the premium tax credits, an average of three out of five uninsured adults eligible for coverage on HealthCare.gov may be able to access a zero-premium plan and nearly three out of four may find a plan for $50 or less per month on HealthCare.gov. HHS also announced an additional $50 million in advertising to bolster the Special Enrollment Period outreach campaign. The campaign will run through August 15, 2021.
HHS OIG: (3/30) - On March 30, HHS Office of Inspector General issued a report finding that about half of states did not provide complete or accurate payment data on Medicaid managed care payments to providers.
Modern Healthcare: (4/1) - During its April Public Meeting, the Medicare Payment Advisory Commission (MedPAC) approved several recommendations that will appear in its June 2021 Report to Congress, including on alternative payment models (APMs). MedPAC will recommend that CMS simplify its approach to APMs by implementing “a more harmonized portfolio of fewer APMs that are designed to work together to support the strategic objectives of reducing spending and improving quality.”
Resident Physician Shortage Act: (3/29) - Reps. Sewell (D-AL) and 38 bipartisan cosponsors introduced the Resident Physicians Shortage Act of 2021 (H.R. 2256), which would take critical steps towards reducing nationwide physician shortages by boosting the number of Medicare-supported residency positions. The bill would support an additional 2,000 positions each year from 2023 to 2029, for a total of 14,000 residency positions.
Florida Medical Association: (4/1) - The Florida Medical Association applauded the Senate passage of a bill (S. 748) to suspend Medicare sequestration cuts that were set to expire at the end of March. FMA had previously advocated on this issue, joining other physician advocates in urging the cuts to be further suspended. FMA President Michael Patete, MD previously sent letters to Sens. Rubio (R-FL) and Scott (R-FL) asking for them to support the bill and urging the moratorium on Medicare sequestration cuts to continue through the public health emergency.
AAFP: (3/31) - In this blog piece, Stephanie Quinn, Senior Vice President of Advocacy, Practice Advancement and Policy at AAFP, reflects on the 11th anniversary of the ACA and how strengthening the health care law starts with Medicaid payment parity. Quinn calls for Congress to move toward Medicaid payment parity by paying primary care physicians at least Medicare payment rates to ensure they are empowered to care for Medicaid patients.
Aledade: (3/31) - Last week, Aledade held a webinar on long-term strategies for maximum shared savings in value-based care. Speakers discussed an overview of value-based care payment models, with emphasis on MSSP and risk-based arrangements; the relationship between long-term MSSP revenues, quality of care, and patient outcomes; an understanding of the gap created by a value-based care system that still pays on a fee for service scale; and three strategies to close the gap and maximize long-term MSSP.
Modern Healthcare: (4/6) - The transition to value-based care has moved slowly, which experts say can impact the financial returns providers can draw from population health management depending on how much of their revenue is tied to risk. This article outlines the struggle providers often face balancing their dependence on fee for service with the transition to accepting value-based payments and how the level of financial return providers see from population health efforts exists on a continuum.
AJMC: (4/6) - This article discusses how to apply an upstream problem-solving approach specific to value-based payment reform and challenges to address suboptimal quality and rising health care costs. Upstream efforts to date have largely focused on addressing social determinants of health, however value-based payment transformation is a key consideration to shift from a downstream approach to addressing health care issues.
Milbank Memorial Fund: (4/5) - A group of independent physicians, health plan administrators, and a state senator in Nebraska partnered to strengthen the state’s primary care infrastructure and align health plans and providers around shared population health goals. Senator Mike Gloor of Nebraska introduced a bill in 2009 to pilot a patient-centered medical home model within the Medicaid program to allow payers to offer primary care practices support, which has since expanded to a statewide model that has the support of primary care clinicians in the state.
National Governors Association: (4/5) - The National Governors Association issued a brief summarizing four areas where states can implement strategies to standardize and streamline broader adoption of value-based payment models. The brief includes case studies and priority areas for federal support to amplify efforts around VBC, and recommends the following four areas for states to consider: adopting a long-term vision, ensuring payer alignment, convening stakeholders to develop a coordinated vision, and collecting data to monitor quality and make improvements.
MedCity News: (4/2) - The COVID-19 pandemic has added urgency to the shift toward value-based care due to the financial insecurity many providers have faced and delayed care patients have put off during the public health emergency. To realign incentives of providers, payers, and patients toward sustainably improving health outcomes in a value-based care system, this article recommends the following changes that employers, insurers, and providers can immediately implement: maximize the use of telehealth, break down the barrier between physical and mental health, and focus on primary prevention.
Modern Healthcare: (4/2) - Over 40 health care systems and insurers in Oregon have committed to boosting their value-based payment models by signing the voluntary Oregon Value-based Payment Compact that aims to tie 70 percent of their payments to capitation and other alternative payment models by 2024. This initiative aligns with Oregon’s cost growth benchmark that went into effect this year and aims to reduce the cost growth rate to 3.4 percent.
Healthcare IT News: (4/2) - In 2011, Intermountain Healthcare started moving toward value-based care to drive affordability and quality. The health system launched Castell, Intermountain’s analytics platform subsidiary, in 2019 to help providers, payers, ACOs and others manage the demands of value-based payment reimbursements. To better partner with both Intermountain providers and independent providers in value-based arrangements, Castell partnered with other vendors to better gather data about the members served to better manage risk contracts and value-based care goals.
AJMC: (4/1) - A survey conducted by the National Alliance of Healthcare Purchaser Coalitions found that 31 percent of employers that are considering the transition to value-based care are considering the benefits design approach, adding to the 35 percent of employers that are already invested in VBC models.
Managed Healthcare Executive: (4/1) - In this interview, Managed Healthcare Executive spoke with François de Brantes, Senior Vice President of Episodes of Care at Signify Health, about value-based care and how the Direct Contracting Model differs from Medicare Advantage.
Managed Healthcare Executive:(3/31) - Value-based care has become critically important to health care leaders reflecting back on the last year of the COVID-19 pandemic. Health care leaders are looking to stabilize provider reimbursements and improve patient outcomes while reducing costs. To make this a reality, this article recommends three steps to consider to work toward the transition to value-based care: interoperability, systemic change, and protecting the vulnerable.
Milbank Memorial Fund: (3/30) - This study looked at the role of primary care providers in providing and coordinating care for vulnerable patients with “long COVID,” or persisting systems associated with the virus beyond three weeks. The study highlights the unique role primary care providers play in providing care for such patients and calls for policy measures that include strengthening primary care, optimizing data quality, and addressing multiple nested domains of inequity to reduce the impact of long COVID on vulnerable groups.
Fee-for-Service to Value: 10 Years of Transforming Healthcare
Value-based healthcare policy developments have restructured the healthcare landscape to emphasize the delivery, measurement, and outcomes of care. Over the past ten years millions of Medicare beneficiaries have been served by innovative payment models. These innovative payment approaches have also been deployed within private coverage. Innovative healthcare providers are successfully delivering improved patient care at lower costs through two-sided risk-based payment models like bundled payment arrangements and accountable care organizations.
Join us on Thursday, April 8 for a virtual educational boot camp focused on understanding and implementing value-based healthcare payment and delivery system reform. You’ll also hear directly from some of the nation’s leading providers and health systems on the barriers they’ve overcome transitioning to alternative payment models and key actions Congress can take to ensure the success of value-based payment initiatives.