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: (9/20) – CMS announced it will host a webinar on September 28 at 2 p.m. (ET) to discuss how CMS employs measures for public reporting, value-based purchasing, and quality improvement. CMS will also provide a brief introduction to quality measures, the measure development process, and how the public can get involved.
CMS: (9/15) – CMS released the Medicare Learning Network (MLN) Connects newsletter, which provides news from the MLN. CMS highlighted the new Enhancing Oncology Model, which aims to improve cancer care for Medicare patients and lower health care costs.
AHRQ: (9/13) – The Agency for Healthcare Research and Quality (AHRQ) released a request for information (RFI) seeking comment on comprehensive, longitudinal, person-centered care planning for people with Multiple Chronic Conditions (MCC) across settings of care, including existing models of person-centered care planning, their current scale, and barriers and facilitators to implementation.
MGMA: (9/21) – Anders Gilberg, MGMA senior vice president of government affairs, was featured on Fierce Healthcare's Podnosis podcast to discuss the biggest issues facing physicians in Congress for the rest of the year, including Medicare payment cuts and extending telehealth flexibilities.
Aledade: (9/15) – Aledade announced that its national value-based care network has helped independent practices, health centers, and clinics deliver more proactive, preventive, primary care to more than 1.15 million patients, saving more than $1.2 billion across the health care system over the past eight years. Dr. Farzad Mostashari, MD, CEO and co-founder of Aledade remarked, “Our 2021 results are a direct reflection of that collective effort, and not only show that our model working, but that it’s working across every type of payer, in every type of community, and is getting stronger over time.”
MGMA: (9/14) – MGMA released a statement following the House passage of the Improving Seniors’ Timely Access to Care Act — critical legislation that would significantly improve the prior authorization process within the Medicare Advantage program. “MGMA urges the Senate to move swiftly to consider this bill, helping to ensure our nation’s seniors have unobstructed access to the high-quality health care they deserve.”
Modern Healthcare: (9/20) – This op-ed from Suzanne Delbanco, executive director of Catalyst for Payment Reform, and Ellen Kelsay, president and CEO of the Business Group on Health, note that their members have demonstrated strong interest in value-based payment strategies, as they lead to better quality and affordability, and urge leaders at health systems and other provider organizations to recognize that the pursuit of coordinated, value-based care is growing among purchasers and embrace financial models enabling it. The authors provide examples of models that providers can adopt, including direct primary care, accountable care organizations, and bundled payments.
Healthcare Exec Intelligence: (9/19) – Research
indicates that organizations moving to value-based care benefit from robust data analytics capabilities and support to fuel the move away from fee-for-service (FFS) reimbursement, including through the use of artificial intelligence (AI) and machine learning. The author notes that AI has significant potential for use in value-based care without sacrificing health equity, but payers, providers, and other stakeholders must be aware how the data and analytical models are being used to ensure bias is not introduced.
Modern Healthcare: (9/19) – This op-ed from Rep. Burgess (R-TX), M.D. highlights his recently introduced legislation, the GOLD Card Act of 2022, which would exempt providers who received approval for 90 percent of their requests in the last 12 months from prior authorization delays for Medicare Advantage beneficiaries. Additionally, the legislation would allow physicians to appeal an attempt by a Medicare Advantage plan to rescind the exemption. Rep. Burgess notes that Texas and West Virginia have also fully adopted a gold carding policy, while at least five other states are interested in adopting such a law.
Modern Healthcare: (9/19) – This op-ed from Rep. DelBene (D-WA) outlines the importance of shifting from FFS to value-based care to improve outcomes and strengthen the Medicare program. Rep. Delbene notes the importance of incentives and protections to encourage participation in value-based care and highlights common-sense changes the federal government can make, many of which are included in DelBene’s Value in Health Care Act, such as for Congress to extend incentive payments to participate in accountable care organizations (ACOs), which expire at the end of this year.
Axios: (9/19) – A recent JAMA study
found that medical debt is associated with higher risks of eviction, food insecurity and bad health outcomes, regardless of insurance or income. The average amount of medical debt in 2018 was $21,867, and compared to white households, Black and Latino people were more likely to have medical debt. The article notes that the rising price of health care is associated with provider consolidation and mergers and acquisitions, which have not been shown to benefit health outcomes.
Modern Healthcare: (9/19) – In 2021, Medicare plans scored better than Medicaid and commercial plans in key quality areas measured by the National Committee for Quality Assurance (NCQA). However, for the first time, the NCQA saw a drop in adult patients’ overall satisfaction with their health care, decreasing from 55.9 percent in 2020 decreasing to 51.8 percent. The author notes that factors playing a role in ratings and performance include communication, care coordination, and the close integration of specialists and primary care doctors, adding that plans that are more integrated tend to have higher member experience and higher quality scores.
HIT Consultant: (9/16) – Only four percent of providers today report using pure FFS, with no links to quality and value, a figure which plummets to one percent by 2025, according to a recent study conducted by Morning Consult and Innovaccer. Further, the study found that 58 percent of providers believe their electronic health record (EHR) vendor will not be able to support the data strategies required to thrive under value-based care. The author notes that digital investments will be the deciding factor for more mature risk-bearing organizations, with the ability to integrate data from EHRs with other silos, such as clinical, claims, telehealth, and social determinants data being the key to successful value-based care.
Commonwealth Fund: (9/15) – Integrating primary care and behavioral health offers a way to address the country’s growing behavioral health crisis while advancing health equity. Challenges to integration include workforce, technology, and provider payment. FFS is a significant barrier to integration, as it disincentives integrated care by reimbursing providers for individual services instead of the whole-care experience. Integrated care can generate savings, and value-based payments have been used to promote integration, generate cost savings, and improve quality.
Healthcare Finance News: (9/15) – This article highlights a recent brief
released from America’s Health Insurance Plans (AHIP) on private equity investments in health care, saying the need of these firms to achieve high returns, including through the use of provider consolidation, directly conflicts with the goal of lowering costs. AHIP proposes several policy solutions, including strengthening antitrust enforcement at the federal and state levels and advancing site-neutral payments to discourage the use of more expensive sites of care as profit engines.
Medhealth Outlook: (9/15) – As hospital consolidation continues, more competition is imperative to support both care quality and reduced costs. One way to accomplish this is by implementing or expanding the use of telemedicine, which smaller practices can leverage to expand the scope of their practice, by increasing access and reducing overheard, while maintaining their independence. While the wide breadth of tools imperative to serve a medically diverse patient population was previously available only to larger facilities, telehealth now allows smaller facilities to treat these kinds of patients through remote patient monitoring technologies and virtual appointment.