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: (7/08) – CMS published a blog outlining recent work to advance health equity through the release of the CMS Framework for Health Equity. One priority area of the framework includes building capacity of health care organizations and workforce to reduce disparities, an example of which is that CMS is considering ways to encourage safety net provider participation in accountable care organizations (ACOs) and value-based care to support providers in identifying and addressing social risk factors.
CMS: (7/07) – CMS issued the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule, which makes payment and policy changes under Medicare Part B and includes proposed changes to the Medicare Shared Savings Program (MSSP) to advance CMS’ overall value-based care strategy of growth, alignment, and equity. CMS is proposing to incorporate advance shared savings payments to certain new MSSP ACOs that could be used to address Medicare beneficiaries’ social needs, allow smaller ACOs more time to transition to downside risk, include a health equity adjustment to an ACO’s quality performance category score, and make benchmark adjustments to encourage more ACOs to participate and succeed. MSSP Fact SheetGeneral Fact SheetQPP Fact SheetBehavioral Health Blog
CMS: (7/06) – CMS unveiled a suite of new resources to improve CMS and state oversight of Medicaid and CHIP managed care programs, which includes tools, templates, and updates on tactics to improve states reporting on their managed care programs. Informational BulletinHHS Press Release
Aledade: (7/08) – Aledade announced that its Fostering Independence, Readiness, Sustainability, and Togetherness (FIRST) program is set to launch in October 2022. The FIRST program aims to illuminate the independent primary care pathway by exposing new physicians to value-based care and highlighting opportunities in Aledade member practices, clinics and community health centers.
AAFP: (7/07) – The American Academy of Family Physicians (AAFP) sent a letter to CMS Administrator Brooks-LaSure, in response to a recent proposed rule on implementing certain provisions of the Consolidated Appropriations Act, 2021 and Medicare eligibility and enrollment rules. The letter echoed detailed guidance AAFP sent federal regulators last month calling for the public health emergency to continue through at least the end of 2022, partly to enable regulators to finalize and implement the Medicare enrollment protections and improvements proposed in this rule.
MGMA: (7/07) – Medical Group Management Association (MGMA) released a statement regarding CMS’ CY2023 Medicare Physician Fee Schedule proposed rule. The letter notes that, “MGMA is incredibly concerned about the likely impact of the proposed 4.42 percent reduction to the conversion factor, especially in light of the financial uncertainty which medical groups have faced over the past two years stemming from the COVID-19 pandemic, inflation, and the staffing crisis."
AAFP: (7/07) – AAFP published a statement expressing concern that the CMS CY2023 Medicare Physician Fee Schedule proposed rule may result in untenable Medicare payment cuts for family physicians in 2023 and jeopardize patients’ timely access to essential primary care. The statement notes that federal Medicare physician payment laws prevent vital investments in primary care, and calls on CMS and Congress to address these limitations amid rising practice costs.
WSHU: (7/11) – Private health care practices are finding financial and labor relief in large hospital systems. However, this leaves patients paying a higher cost for health care in a less personal setting. This article outlines more on what is contributing to consolidation and a decreased number of providers working in independently-owned practices.
Health Affairs: (7/11) – Recent debate around prior authorization in Medicare Advantage plans has focused on the process of prior authorization rather than which specific clinical services are actually subject to it. By deploying prior authorization in the right ways for the right purposes, Medicare Advantage can cement its role as a leader in value based care while protecting seniors and reducing costs for beneficiaries and the health care system alike.
AMA: (7/11) – Models for physician payment and compensation are notable for their variation and complexity. During a recent webinar held by the American Medical Association on issues in physician compensation, panelists noted that COVID-19 introduced more complexity in this space, but also introduced needed flexibility from both government and private payers leading toward more adoption of value-based concepts.
AJMC: (7/11) – This study outlined results from a survey conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient. Primary care providers were asked about their involvement in cancer care and value-based care, among other questions. Twenty-four (45.3 percent) reported value-based metrics as “somewhat” or “very” important when asked how important it would be to refer a patient to an oncologist who contracted with a health plan with a value-based payment model.
Health Payer Intelligence: (7/11) – According to a recent study published in Health Affairs, chronic disease management in diabetes may benefit slightly from value-based care and alternative payment models. The study examined whether alternative payment models (APMs) can improve the value of diabetes care, finding that higher-risk APMs yielded greater improvements in diabetes process measures than lower-risk APMs and that value-based insurance design (VBID) models appeared to improve medication adherence but not other quality measures.
The New England Journal of Medicine: (7/09) – The movement toward value-based payment has been a defining feature of U.S. health care reform during the past decade. Models like the ACO REACH model have been launched to address concerns about inequitable effects of value-based payment programs and to promote both value and equity as a central goal. This article outlines how several provisions of the ACO REACH model could help advance health equity and move the health care system toward a more progressive value-based payment approach.
Health Affairs: (7/08) – Primary care physicians stand at the front line of ensuring the highest possible level of physical and behavioral health for people throughout their lifetime, and aim to do this while navigating the challenges of limited time with patients and often inadequate resources. The authors of this article believe that primary care systems must urgently embrace a paradigm shift, accelerating the adoption of behavioral health integration in physician practices and addressing this increase in unmet needs.
JAMA Network: (7/08) – This study looked at whether the CMS Value-Based Purchasing (VBP) program is associated with changes in patient-reported experience in safety-net versus non-safety-net hospitals. The study found that safety-net hospitals had lower performance than non–safety-net hospitals across all measures of patient experience and satisfaction. Findings suggest that the VBP program implementation was not associated with improvement in measures of patient experience in safety-net vs. non–safety-net hospitals.
Health Affairs: (7/08) – In previous Health Affairs blogs, Drs. Don Berwick and Rick Gilfillan argue that MA plans receive higher premiums relative to what CMS would pay in traditional Medicare. One of their recommendations is to eliminate the disease-based risk-adjustment hierarchical condition category (HCC) risk scoring system. While these original posts addressed the role of risk adjustment in the MA system (the subject of this response), the subsequent debate has been more concerned with the MA business model and its effect on member quality and financial outcomes.
Medical Economics: (7/06) – Various regulations, initiatives, and platforms seek to unlock data from separate silos for free-flowing exchange that enhances the patient experience and enables data-driven improvements in health outcomes. Health plans and providers remain invested in using data to achieve improved care coordination while lowering costs. This article discusses five adoption habits that will guide the essential transition to value-based care for leveraging patient data.