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: (6/27) - The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the new, voluntary Enhancing Oncology Model (EOM), which is intended to transform care for cancer patients, reduce spending, and improve the quality of care. The model is designed to test how best to place cancer patients at the center of the care team that provides high-value, equitable, evidence-based care. The model’s design incorporates many of the lessons that CMS learned from the Oncology Care Model (OCM) (tested from July 1, 2016 – June 30, 2022) and feedback from the oncology community, and will require participating Physician Group Practices to take on accountability for their patient’s health care quality and for total spending during a six-month episodes of care for Medicare patients with certain cancers. Applications will be open from June 27 - September 30, 2022. Request for Applications
HHS: (6/24) - The HHS Office of the Assistant Secretary for Health (OASH) released a request for information on what the federal government could do to strengthen primary health care in the U.S. Specifically, OASH seeks input from the public about innovations, models, solutions to barriers, and possible HHS actions that may strengthen primary health care to promote health equity, reduce disparities, improve access to care, and improve outcomes. Comments are due by August 1, 2022.
White House: (6/24) - The White House released the Blueprint for Addressing the Maternal Health Crisis, a whole-of-government approach to combating maternal mortality and morbidity. The Blueprint outlines five priorities to improve maternal health and outcomes in the United States: (1) Increasing access to and coverage of comprehensive high-quality maternal health services, including behavioral health services; (2) Ensuring women giving birth are heard and are decision makers in accountable systems of care; (3) Advancing data collection, standardization, harmonization, transparency, and research; (4) Expanding and diversifying the perinatal workforce; and (5) Strengthening economic and social supports for people before, during, and after pregnancy.
HHS: (6/23) - HHS announced the approval of Colorado's Section 1332 State Innovation Waiver amendment request to create the "Colorado Option," a state-specific health coverage plan that aims to increase health coverage enrollment and lower health care costs, making insurance more affordable and accessible for nearly 10,000 Coloradans starting in 2023. CMS Press Release
CMS: (6/23) - CMS released a report and toolkit by the Medicaid and CHIP Coverage Learning Collaborative for state Medicaid and CHIP agencies to use in the event of a public health emergency or disaster. The report provides a summary overview and inventory of available strategies and authorities available to support Medicaid and CHIP operations and beneficiaries, and the toolkit consists of three modules and serves as a comprehensive preparedness and response toolkit.
CMS: (6/23) - CMS released the second annual report for the Pennsylvania Rural Health Model. The report confirmed findings from the first evaluation report that global budgets continued to help stabilize finances for participating hospitals.
House Energy & Commerce Committee: (6/28) – The House Energy & Commerce Committee, Subcommittee on Oversight and Investigations held a hearing on oversight of private sector Medicare Advantage (MA) plans to examine the quality of care America’s seniors are receiving through such plans. Topics discussed included the need for prior authorization to be electronic, and that while MA has many benefits, CMS should improve its oversight on MA to ensure that these plans continue to provide quality care. Last week, Ranking Member McMorris Rodgers (R-WA) and Subcommittee on Oversight and Investigations Ranking Member Griffith (R-VA) invited CMS Administrator Chiquita Brooks-LaSure to testify before the committee during this hearing, as they noted she was best positioned to speak to the details and operations of the MA program.
Bipartisan Safer Communities Act: (6/25) – After passage in the Senate and House last week, President Biden signed into law the Bipartisan Safer Communities Act (S. 2938), which will enhance certain restrictions and penalties on firearms purchases, promote evidence-based best practices for school safety, authorize grants to expand access to mental health services, and appropriate emergency funding for mental health resources and school safety measures. The bill passed the Senate on June 23 and passed the House on June 24.
House Appropriations Committee: (6/23) – The House Appropriations Committee, Subcommittee on Labor, HHS, Education, and Related Agencies passed the Fiscal Year 2023 Labor, Health and Human Services, Education, and Related Agencies Funding Bill by voice vote. The funding bill would make significant investments in mental and behavioral health, maternal health care, health care workforce development, public health programs, and more. The bill now heads to the full House Appropriations Committee for consideration.
CLIMB Act: (6/23) – Reps. Houlahan (D-PA), Meijer (R-MI), and Hill (R-AR) introduced the Children’s Literacy Initiative on Military Bases (CLIMB) Act (H.R. 8208), which would promote early literacy among certain young children as part of pediatric primary care.
Building a Sustainable Workforce for Healthy Communities Act: (6/21) – Rep. Ruiz (D-CA) introduced the Building a Sustainable Workforce for Healthy Communities Act (H.R. 8151), which would provide awards to support community health workers and community health. The bill will be considered in a legislative hearing before the House Energy & Commerce Committee, Subcommittee on Health on June 29.
AAFP: (6/23) – With much of the U.S. riding out another COVID-19 infection surge, the American Academy of Family Physicians this month delivered urgent new guidance to federal regulators and called for the PHE to continue through at least the end of the calendar year 2022. “We strongly believe a comprehensive plan is needed to provide the public with ample notice ahead of a slew of policy changes,” said the AAFP in a June 17 letter. “The AAFP strongly recommends HHS publish a comprehensive plan outlining all the existing flexibilities and policies that will change once the federal PHE declaration expires. HHS should offer the public at least 60 days to comment on this plan and should work with other departments, such as Treasury and Labor, to outline how it will minimize disruptions and address gaps in health care coverage and access.”
Annals of Internal Medicine: (6/28) – Over the past four decades, many efforts have sought to improve the delivery of primary care. Each practice improvement initiative has promise, and sometimes scientific evidence of efficacy, to improve care for the single disease or process targeted. Yet, implementation of initiatives requires time, training, possible practice redesign, and growing administrative burden. Initiatives also may require extensive patient education to manage or reframe expectations. These efforts may yield additional payment, but often the remuneration is not commensurate with the administrative burden required to claim it.
Healio News: (6/28) – Many physicians have looked at different organizational structures for joint ownership. Many independent groups have been faced with sale to local hospitals or health systems, leading to concern among physicians around loss of autonomy. The pandemic exacerbated this and, as a result, led to interest in other models. This article explores physician-management models as an alternative to private equity.
Newswire: (6/28) – The Health Care Transformation Task Force (HCTTF) announced the release of a new resource titled “Stories from the Field: Implementing Principles of Person-Centered Care.” The Implementation Guide provides best practices that exemplify the Task Force’s guiding patient-centered care principles. It also includes an operational “checklist” of steps and processes that successful health care organizations use to achieve their patient-centered care and health equity goals. The Implementation Guide serves as a companion resource to the Person-Centered Care as a Cornerstone of Value-Based Payment: Five Guiding Principles that the Task Force released in 2021.
Health Affairs: (6/27) – Diabetes process and outcome measures are common quality measures in payment reform models, including Alternative Payment Models (APMs) and value-based insurance design (VBID). VBID is a benefit design strategy that reduces patients’ out-of-pocket spending requirements for high-value care and sometimes increases out-of-pocket spending for low-value care. Unlike APMs, VBID models put the onus of incentivizing quality on payers rather than providers. This commentary reviews evidence from selected research to examine whether these payment models can improve the value of diabetes care.
Managed Healthcare Executive: (6/27) – Medicaid managed care organizations (MCOs) may be better equipped to address social determinants of health and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination. For providers to effectively deliver value-based care and proactively minimize health risks, they need to understand how SDOH are impacting their members. This article describes why SDOH are a critical factor for preventing member risk escalation in value-based care.
Health Leaders: (6/24) – The American College of Physicians (ACP) has proposed a seven-part set of reforms to link physician payment to value and equity rather than volume of services. Policymakers and lawmakers have been seeking to replace fee-for-service reimbursement in health care with value-based payment models since passage of the Patient Protection and Affordable Care Act in 2010. The position paper urges more meaningful efforts to create value-based payment models, noting that “policy leaders and the clinical community must work together to make progress toward equity using value-based payment.”
AJMC: (6/23) – Florida Cancer Specialists & Research Institute (FCS) was an early adopter of value-based care initiatives. For nearly a decade, its physician, pharmacy, and business leaders have been active participants in the Oncology Care Model (OCM), and equally active in policy discussions at the state and national levels about the future of payment reform. The holistic approach of FCS to value-based care goes back to the proverbial Triple Aim in health care: that is, improving patient experience, improving population health, and reducing cost. FCS is making sure that these factors of value-based care are working together in a balanced fashion.
AJMC: (6/23) – The Oncology Care Model (OCM) is set to end June 30, 2022. However, the end of the model does not mean the lessons of value-based care will cease. The challenge, many providers say, will be figuring out how to keep what worked in the OCM without the support of the model’s Monthly Enhanced Oncology Services (MEOS) payments, which helped practices afford navigation and nutrition services and social workers. The OCM has created “a good foundation” for commercial plans to build value-based models in oncology, and for regulators to pursue the next wave of reform in Medicare.
Benefits Pro: (6/22) – Over the past decade, value-based care and its corresponding contracts have become extremely popular in the managed care industry. These arrangements are a large and growing area of focus for a variety of health care stakeholders: networks, providers, governments, and employers. There are many examples of major payers adding more value-based care models - Optum, for example, has stated that value-based care is “vital for survival.” For the health care system to achieve greater value, we must work to understand, track, and manage care by the true definition of value: the price, efficiency, and quality of the care delivered from the service unit to the care pathway.
Doc Wire News: (6/22) – DocWire News spoke with Dr. Jonathan Slotkin, chief medical officer at Contigo Health (a Premier company), who spoke about the ongoing shift to value-based care, among other topics. In regards to value-based care, Dr. Slotkin stated that “COVID-19 has really underscored the transition to value-based payment models. The transition needs to be really meaningful and well beyond what we see now in value care, which is modest scale and pilot efforts.”
Health Affairs: (6/22) – The Altarum Research Consortium for Health Care Value Assessment is taking the next step to address gaps and advance better value across the health system by forming the “Broader Value Initiative”. The Broader Value Initiative’s first step will be to convene an “Expert Panel on Health Care Value”—a multi-stakeholder working group that brings together leading experts from a wide range of disciplines and stakeholder perspectives to recommend concrete steps to address barriers to understanding health care value across the system.