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News Clips
Health Affairs: Can ACOs Flex While Supporting Specialty Care? (5/1) – The ACO PC Flex Model advances value-based care by moving beyond fee-for-service and grants ACOs the flexibility to work with their primary care providers to transform how primary care is delivered. Building on these efforts, CMS should explore additional opportunities to advance capitation beyond primary care. For example, in coordination with its specialty care strategy, CMS should allow ACOs to design capitation arrangements with certain specialists who are managing care for patients with chronic conditions. The goals of improving the quadruple aim are shared across ACOs. To catalyze the transition to value-based, population health models, we must continue to align incentives.
Washington Post: UnitedHealth grew very big. Now, some lawmakers want to chop it down. (4/30) – For decades, UnitedHealth’s staggering growth attracted relatively little Washington scrutiny, particularly compared with drugmakers repeatedly summoned to Congress to testify on price increases. Federal antitrust officials also traditionally focused on blocking companies from gobbling up direct competitors, known as horizontal integration, while being more permissive of the strategy practiced by UnitedHealth, which involves buying a stake in different sectors of the same industry, known as vertical integration. But lawmakers and regulators are beginning to frame UnitedHealth’s sweeping operations as an economic and national security concern. Exhibit A: the February cyberattack on a UnitedHealth subsidiary that processed more than 40 percent of the nation’s medical claims. The hack froze payments, preventing many hospitals, doctors and other providers from being paid for weeks. It also interfered with patients’ prescriptions and caused industry paralysis still being repaired today.
RevCycle Intelligence: How to address health equity in alternative payment models (4/29) – APMs incentivize health care providers to deliver high-quality, coordinated care to patients. The CMS Innovation Center regularly tests new payment and delivery models to identify which strategies successfully improve care and lower costs. For the Health Care Payment Learning & Action Network (HCP LAN), there are three main components of APMs: payment and incentives, how a health care delivery system is organized, and performance metrics. Additionally, APMs must prioritize three major areas when designing their strategy. First, APMs should directly reward reductions in health disparities. Second, models should consider how upfront funding can be used for equity purposes, and third, payments should be adjusted for the social risks of the populations served.
Newton News: Opinion: Independent physician practices are disappearing — that’s bad for patients (4/29) – The gradual disappearance of independent physician practices is not in patients’ interests. Policymakers must ensure that our health care system does not discriminate against independent practices — and unwittingly put them out of business. The health care market has been consolidating for decades. As of 2021, more than half of doctors worked for hospitals or health systems, according to research conducted by Avalere Health for the Physicians Advocacy Institute. But independent practice offers patients and the health care system many benefits. Research shows that independent physician practices have more success getting patients to follow a prescribed treatment plan and post significantly lower rates of preventable hospital admissions and readmissions. Their patients also report higher levels of satisfaction.
Modern Healthcare: Why some conservatives are targeting healthcare consolidation (4/24) – The call to rein in giant healthcare corporations isn't just coming from the left. Conservative lawmakers on Capitol Hill are growing increasingly vocal with their own demands to crack down on consolidation and vertical integration in the industry, spurred on most recently by the Change Healthcare ransomware attack. A House Energy and Commerce Committee hearing last Tuesday regarding the incident — which has disrupted provider and payer operations for weeks — largely focused on cybersecurity. But frustration also boiled over at the size and scope of UnitedHealth Group and its subsidiary Optum, which bought Change in 2022 over the initial objections of the Justice Department.
STAT: The evidence grows: Prices spike after mergers between far-flung hospitals (4/23) – A study released Tuesday adds to a growing body of evidence that prices still go up even if the merging hospitals are far apart. The FTC has never tried to block such cross-market mergers, but antitrust experts say these latest findings add to what could become a strong legal argument against the deals. “The findings stand for themselves as yet another demonstration that these mergers really are causing price increases,” said Katherine Gudiksen, a study author. Six years after cross-market mergers, prices increased almost 13 percent at the acquiring hospitals, according to the study. They shot up 21.8 percent when the market share of the acquired hospital was bigger than the acquirer’s, and 9.7 percent when the opposite was true. And — contrary to the assertions of every merger press release — the deals had no impact on key quality metrics.
RevCycle Intelligence: Portal allows public reporting of anti-competitive behaviors (4/23) – A new online portal allows the public to report any anti-competitive behaviors they see in the health care sector that may be impacting quality of care and affordability. The FTC, Justice Department and HHS launched the portal HealthyCompetition.gov on April 18th to further the Biden Administration’s efforts to lower health care costs and create more competitive health care markets. “Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” HHS Secretary Xavier Becerra said in a statement. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors."
KFF: Medical Providers Still Grappling With UnitedHealth Cyberattack: ‘More Devastating Than Covid’ (4/19) – Two months after a cyberattack on a UnitedHealth Group subsidiary halted payments to some doctors, medical providers say they’re still grappling with the fallout, even though UnitedHealth told shareholders on Tuesday that business is largely back to normal. “We are still desperately struggling,” said Emily Benson, a therapist in Edina, Minnesota, who runs her own practice, Beginnings & Beyond. “This was way more devastating than covid ever was.” Meanwhile, the House Energy and Commerce Health Subcommittee held a hearing April 16 seeking answers on the severity and damage the cyberattack caused to the nation’s health system. Subcommittee Chair Guthrie (R-KY) said a provider in his hometown is still grappling with the fallout from the attack and losing staff because they can’t make payroll. Providers “still haven’t been made whole,” Guthrie said. Rep. Pallone (D-NJ) voiced concern that a “single point of failure” reverberated around the country, disrupting patients’ access and providers’ financial stability.
KFF: Ten Things to Know About Consolidation in Health Care Provider Markets (4/19) – This issue brief identifies ten things to know about consolidation in health care provider markets, touching on topics such as the different types of consolidation, trends, ways in which consolidation can be beneficial or harmful for patients and other consumers, some key findings from existing research, and policy options for increasing competition. This brief focuses on consolidation among health care providers, rather than health insurers, and builds on a 2020 KFF issue brief on provider consolidation. More recent research has not altered the key takeaways pulled from that brief.
STAT: Former HHS secretaries: Congress should adopt site-neutral payments for health care (4/18) – As two former secretaries of Health and Human Services, we are all too familiar with the struggle of finding narrow openings for bipartisanship. Despite our different approaches, we believe that addressing health care costs is a truly bipartisan issue. To be serious about creating access for people to the best possible care, that care must be affordable for patients and taxpayers. One issue that is particularly ripe for bipartisan compromise is site-neutral payments. Even though we served under presidents for different parties, we both recommended that Congress adopt policies advancing site-neutral payments to save patients and taxpayers money. People should pay for the care they receive, not for the sign on the door.
Healthcare Dive: ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says (4/17) – ACOs led by independent physicians save Medicare more money than other types of ACOs, according to a new Congressional Budget Office review of existing research. Independent physician-led ACOs have clear financial incentives to reduce hospital care to lower spending, while hospital-led ACOs — which earn more revenue when patients are admitted — do not, the CBO found. Hospitals also have less direct control over what services patients receive. ACOs with a larger proportion of primary care providers also saved Medicare more money, along with ACOs whose initial spending was higher than their peers in the same region, according to the report.
Healthcare Dive:
CMS to Test Mandatory 5-Year Episode-Based Alternative Payment Model (4/17)
– The mandatory Transforming Episode Accountability Model (TEAM) would aim to improve the patient experience from surgery through recovery by supporting the coordination and transition of care between providers and promoting a successful recovery that can reduce avoidable hospital readmissions and emergency department use. TEAM episodes would begin with lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. The CMS Innovation Center said that the model is designed to complement longitudinal care management through policies that align with ACOs and promote primary care referral. Under TEAM, a person receiving care from providers in an ACO would still be able to be in an episode if they receive one of the surgeries included in TEAM at a hospital that is selected to participate in TEAM. The Innovation Center added that allowing a person with traditional Medicare to be included in both TEAM and ACO initiatives would help to promote provider collaboration to find opportunities to improve quality of care and reduce Medicare spending.
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