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.
Health Affairs: (7/05) – This article, written by CMS Innovation Center staff, outlines results from a review of three existing experimental payment and service delivery models to determine whether implicit bias may be present, and if so, whether such bias has led to the unintentional exclusion of certain beneficiary groups from the models. The results of the analysis will inform broader efforts to address bias across the Innovation Center’s models.
HHS: (7/01) – HHS announced over $155 million in awards for 72 teaching health centers that operate primary care medical and dental residency programs that include high need specialties such as psychiatry, as part of President Biden’s Unity Agenda to address the nation’s mental health crisis. HRSA’s Teaching Health Center Graduate Medical Education program focuses on supporting residents in primary care residency training programs to meet the medical and mental health care needs of rural and underserved communities.
CMS: (6/30) – CMS announced that it has notified applicants of their provisional acceptance into the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, which is set to launch on January 1, 2023.
CMS: (6/30) – CMS released newly updated Coverage to Care (C2C) resources to help those served by CMS understand their health coverage and get health care services they need. Updated resources include the Roadmap to Better Care, Roadmap to Behavioral Health, Prevention Flyers, and more.
CMS: (6/30) – CMS released a proposed rule establishing conditions of participation (CoPs) for Rural Emergency Hospitals (REH) and modifying certain CoPs for Critical Access Hospitals. Comments are due by August 29, 2022. Fact Sheet
White House: (6/30) – The White House issued a fact sheet on health sector leaders joining the Biden Administration in its pledge to reduce greenhouse gas emissions by 50 percent by 2023. The pledge was signed by 61 organizations, leading health sector suppliers, and major medical associations like the National Academy of Medicine.
CMS: (6/29) – CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP, including the Medicare Monthly Enrollment data which provides current monthly information on the number of Medicare beneficiaries with hospital/medical coverage and prescription drug coverage, available for several geographic areas including national, state/territory, and county.
Sen. Shaheen (D-NH): (6/30) – Sen. Shaheen (D-NH) led a group of Senators on a letter to Senate Majority Leader Schumer (D-NY) and House Speaker Pelosi (D-CA), urging congressional leadership to prioritize making permanent the ACA enhanced premium tax credits in upcoming reconciliation legislation, which are set to expire at the end of this year.
The House Appropriations Committee: (6/29) – The House Appropriations Committee approved the fiscal year 2023 Labor, Health and Human Services, Education, and Related Agencies appropriations bill on a 32 to 24 vote. The bill provides $242.1 billion, an increase of $28.5 billion – 13 percent – above 2022. Notably, the report language accompanying the bill included language that would require GAO to conduct a report on health care consolidation across Medicare and Medicaid, encourages CMS to work with stakeholders to develop the Radiation Oncology model and fulfill a report requested on the model, address health care provider shortages, and establish a Population Health Task Force within HHS that would include experts on value-based care, among other notable inclusions. Draft TextBill before adoption of amendmentsReport
Health Affairs: (6/30) – Leaders from Aledade published a blog commenting on recent publications from CMS highlighting the agency’s federal strategic vision for value-based care. Aledade noted that achieving these goals will require urgency and action on several fronts, and offered recommendations for CMS to meet its goals, including to provide financial incentives to ACOs serving high-priority populations and test financial benefits for seniors in ACOs, among others.
Florida Medical Association: (6/29) - Florida Medical Association (FMA) published a new blog on a recent study related to telehealth access and utilization in Medicare during the COVID-19 pandemic. FMA has advocated that the telehealth flexibilities enacted during the public health emergency, which providers have used to ensure patients can continue accessing care, have saved lives without increasing costs.
AAFP: (6/17) – AAFP sent a letter to HHS Secretary Becerra outlining a number of considerations for ensuring timely access to care after the COVID-19 public health emergency (PHE). 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, giving the public at least 60 days to comment on this plan. The AAFP also recommends that the federal PHE continue through at least the end of 2022.
AJMC: (7/05) – At AHIP 2022, Vanessa Bobb, MD, PhD, FAPA, vice president of Behavioral Health & Medical Integration at CDPHP, moderated a session on real-world study findings showcasing cost and quality benefits of value-based contracting in behavioral health. Bobb discussed findings of the study and how value-based programs can be better leveraged in mental health and substance abuse care.
Newswire: (7/05) – A Weber Shandwick study found that about 73 percent of Americans now find health care-related information online, which is only expected to increase with time. Whether researching symptoms or seeking recommendations for a physician, the users rely on the internet for several health care-related decisions. This article outlines digital tools that independent medical practitioners can use to account for this trend.
Benefits Pro: (6/30) – In the value-based care delivery model, providers are paid based on patient health outcomes. Under agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. To achieve true value for the health ecosystem – payer, provider, employer, and member – benefits advisors and their employer clients should expect claims management, payment integrity, care management, and member engagement to work together seamlessly.
AJMC: (6/29) – Kidney care is characterized by complex patient needs that create high risk for payers and providers. Managing this risk while optimizing patient outcomes cannot be achieved with traditional fee-for-service (FFS) models, with public and private payers largely transitioning to the adoption of value-based care programs. Terry Ketchersid, MD, MBA of the Integrated Care Group, Fresenius Medical Care noted during a session at AHIP 2022 that, ”When these value-based care models are put together appropriately, both the payers' and the providers' interests are aligned, and the winner is ultimately the patient, because in these value-based care models, we can actually buy things for patients that we cannot afford in a transactional FFS environment.”
Medical Economics: (6/29) – According to, Timothy Hoff PhD, nothing in the U.S. health care system will be or should be the same after a two-year global pandemic. Our primary care system has recovered in some ways from the sudden financial shock and the loss of patients, but a closer look suggests that many of the challenges that existed pre-pandemic related to investments and resources still remain. This article includes a strategic blueprint detailing how to fix the primary care system with five goals, including to transform the way health care treats the primary care workforce.
Health Affairs: (June 2022) – The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. Researchers examined whether this model provided better results for beneficiaries with ESRD than primary care–based ACO models, finding significant decreases in Medicare payments ($126 per beneficiary per month), hospitalizations (five percent), and likelihood of readmissions (eight percent) among beneficiaries with ESRD during the first year of alignment with the CEC Model and no impacts on these measures among beneficiaries with ESRD who were aligned with primary care–based ACOs, relative to fee-for-service Medicare beneficiaries. The strategies that enabled ESRD Seamless Care Organizations to achieve reductions in hospitalizations and readmissions could inform physician-led ACOs’ efforts to coordinate with hospitals in their areas.