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 Innovation Center: (5/17) – CMS released the fourth annual evaluation report for the Comprehensive Primary Care Plus model. The report found CPC+ reduced acute care utilization and acute inpatient expenditures and improved some claims based quality-of-care measures. Some types of expenditures increased, so CPC+ did not reduce total Medicare expenditures. SummaryReport
CMS Innovation Center: (5/12) – CMS announced the CY 2023 Benchmarks and Achievement Thresholds for the Expanded Home Health Value-Based Purchasing Model. The model was designed to incentivize all Medicare-certified home health agencies to provide higher quality and more efficient care within the Medicare Home Health Prospective Payment System. OverviewAccess instructions
Rep. Sewell (D-AL): (5/12) – Rep. Sewell (D-AL) and five cosponsors introduced the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act (H.R.7755), which would improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation. On April 7, Sens. Booker(D-NJ), Padilla (D-CA) and Brown (D-OH) introduced companion legislation in the Senate (S.4067).
Medical Group Management Association (MGMA): (5/11) – MGMA sent a letter to HHS Secretary Becerra urging him to renew the COVID-19 public health emergency (PHE) declaration for at least another 90 days to allow for additional time to wind down the flexibilities that are in place.
Aledade: (5/9) – On Aledade’s ACO Show podcast, Mat Kendall, President of Aledade, and Kristy McGlothin, Program Manager, speak about Project Solo, Aledade’s initiative to support the unique needs of small private practices. They also speak with an internal medicine primary care provider about being independent and what it’s like to switch ACOs.
Health Affairs: (5/18) – In Part Two of the article series “ACO REACH And Advancing Equity Through Value-Based Payment,” the authors continue the discussion of the framework for categorizing the spectrum of approaches they identified for improving equity through value-based payment (VBP) model design.
Health Affairs: (5/17) – In this article, the authors present a framework for categorizing the spectrum of approaches for improving equity through VBP model design. The authors discuss the key design elements for explicitly addressing equity in ACO REACH; highlight examples (and evidence or early lessons, where available) of how some states and commercial payers have approached those same design elements; and identify additional opportunities for the Innovation Center and other parts of CMS, states, and commercial payers to continue to test ways to embed equity in VBP models.
Modern Healthcare: (5/17) – Between March and December 2020, hospitals performed more than 100,000 procedures on older patients that have been deemed overused, according to an analysis of Medicare claims data from 2018 through 2020. These services, which are thought to offer little to no clinical benefit for patients and present additional risks, include hysterectomies for benign disease, coronary stents for stable heart disease and spinal fusions for lower-back pain.
Modern Healthcare: (5/17) – The health insurance industry wants policymakers to require more transparency of private equity healthcare deals and increase oversight of health system consolidation, the trade group AHIP wrote in letters to President Joe Biden and congressional leaders. AHIP outlines policies it argues would improve competition in the healthcare system and reduce costs. "In too many segments of our healthcare system, competition has been stymied by powerful healthcare providers and drug manufacturers gaming the rules to their advantage and inadequate laws and enforcement to protect competitive markets," AHIP wrote.
Fierce Healthcare: (5/17) – Following opposition from New Hampshire’s attorney general, Dartmouth Health and GraniteOne Health have officially called off plans to merge, a representative of the former confirmed. The two organizations had signed a letter of intent back in January 2019 to form a combined non-profit health system they said would expand access to care for New Hampshire patients, particularly across the state’s southern and rural regions.
Fierce Healthcare: (5/17) – Humana's CenterWell and Welsh, Carson, Anderson and Stowe are teaming for a second joint venture focused on value-based primary care. Through the venture, the two partners will deploy $1.2 billion to develop 100 new senior-focused primary care clinics between 2023 and 2025, and then operate these locations to ensure they reach profitability. Humana and WCAS first joined forces in February 2020, a partnership that is putting $800 million toward opening 67 clinics by early 2023.
Fierce Healthcare: (5/17) – Private insurance plans paid hospitals on average 224 percent more compared with Medicare rates for both inpatient and outpatient services in 2020, a new study found. Researchers at RAND Corporation looked at data from 4,000 hospitals in 49 states from 2018 to 2020. While the 224 percent increase in rates is high, it is a slight reduction from the 247 percent reported in 2018 in the last study RAND performed.
RevCycleIntelligence: (5/17) – Data sharing is one of the most significant barriers to value-based care for providers. The key is to focus on sharing information in a way that primarily benefits the patients and their health outcomes. Interoperability is key to optimizing data sharing and achieving success under value-based care models. Providers must have timely access to data to understand if they are within budget and, if they are not, what is putting them over budget. Providers also need feedback from payers to understand their progress toward meeting quality measures.
JAMA Network: (5/17) – In this study, the authors examined the association between value-based payment and acute care use in a national population of MA beneficiaries. They found in a study population of 489 796 MA beneficiaries, value-based payment was significantly associated with lower acute care use. Compared with Fee-For-Service, beneficiaries cared for under two-sided risk models had lower rates of hospitalizations, observation stays, and ED visits.
Health Payer Intelligence: (5/16) – CareOregon and the Alliance for Culturally Specific Behavioral Health Providers have developed an alternative payment model that seeks to empower culturally specific provider services. The newest update to the payment model expanded payments for culturally specific providers by as much as 20 percent overall to better reward the time and expertise required for offering culturally-specific care and health equity in care. The expansion included both a boost to payment rates and an increase in Health Related Service reimbursement.
Health Payer Intelligence: (5/16) – Payers can offer essential support to providers starting their journey through the value-based care continuum, while further research on value-based care in Medicare Advantage can help inform payers about best practices in this endeavor. Value-based care in Medicare Advantage helped maintain quality of care during the coronavirus pandemic, with Humana’s Medicare Advantage beneficiaries seeing a 20 percent lower hospitalization rate than traditional Medicare beneficiaries in 2020. However, research on value-based care in Medicare Advantage is not as robust as studies on fee-for-service Medicare.
Modern Healthcare: (5/16) – Too often, practices make the mistake of believing they will succeed in value-based care by simply joining or forming an accountable care organization or clinically integrated network. But success actually hinges on alignment with physicians on the business and patient care goals of your value-based care strategy. Physician engagement in value-based care strategy remains a challenge associated with the contracts, making their buy-in nothing short of essential. Just 23 percent of respondents said the majority of physicians are engaged with the organization’s value-based care strategy.
JAMA Health Network: (5/13) – In this cross-sectional study of 2163 US hospitals, a sizeable reduction in the operating margins of US hospitals was found in 2020. The study results suggest that the COVID-19 relief fund effectively offset the operational financial losses of hospitals during the COVID-19 era, particularly for government, rural, and smaller hospitals, which are typically more financially vulnerable and have been supported by some targeted fund allocation.
Health Affairs: (5/13) – In this article, Dan Crippen explored the question of whether selection by voluntary providers contributed to the disappointing results of CMS Innovation Center demonstrations. This article summarizes a multitude of analyses surrounding the reasons the demonstrations show little savings or quality improvement. The analyses indicate that the failure was not due to voluntary, as opposed to mandatory, participation by providers. The article then suggests several ways that any future selection challenges could be addressed, should they occur, without requiring mandatory participation.
Fierce Healthcare: (5/13) – As the industry continues its march toward value-based care, it should do so with a critical eye, says Sachin Jain, M.D., CEO of SCAN Health Plan. Jain told Fierce Healthcare that value-based care has become akin to religion, with the industry taking it on faith that these models will drive beneficial change. But there are potential pitfalls, and an open dialogue about them is necessary to make sure value-based models evolve to serve patients effectively.
Fierce Healthcare: (5/13) – New legislation in the House and Senate aims to increase the role of health equity in the development of value-based payment models, including a demand that the Biden administration create a model specifically on dual-eligible beneficiaries, behavioral health and maternal mortality.The John Lewis Equality in Medicare and Medicaid Treatment Act, introduced Thursday by Rep. Terri Sewell, D-Alabama, aims to advance equity in the work of the Center for Medicare and Medicaid Innovation (CMMI). The legislation, a companion for which was introduced last month in the Senate, comes as addressing equity is a major priority for the center and the Biden administration.
American Medical Association: (5/12) – Dr. Gerald Harmon, President of the AMA, wrote a piece about the importance of physician-led teams. He says “every team needs a leader—and in any team-based model of health care delivery, the most capable and most cost-effective team leader is a physician.The AMA strongly supports the team approach in which each member fulfills a clearly defined role based on his or her expertise and training. Physicians bring unique skills, training and experience to bear in diagnosing and treating patients—and patients count on that expertise and expect that a physician will direct their care.”
Healthcare Dive: (5/12) – The Advocate Aurora Health and Atrium Health merger is likely to get a close review from the Federal Trade Commission as the Biden administration has taken a tougher stance on healthcare consolidation, antitrust and legal experts say. “It doesn’t raise the same red flags, but it doesn’t mean that it gets waved through,” said Leemore Dafny, a Harvard Business School professor and former deputy director of healthcare and antitrust at the FTC. The FTC is likely to examine whether the two systems negotiate with the same insurers even if they’re in different geographic locations, Dafny said.
Bloomberg: (5/11) – Hospital labor costs have soared by more than a third during the pandemic, a new report shows, the latest evidence of the pressures it has exacted on health-care providers. Labor costs rose 37 percent per patient between 2019 and March 2022, according to health-care consultancy firm Kaufman Hall, which called the first quarter of this year “a perfect storm of expense, volume, and revenue pressures.”
Modern Healthcare: (5/11) – Advocate Aurora Health and Atrium Health will form a $27 billion health system spanning seven states, making it the sixth largest health system in the country, the not-for-profit providers.The transaction represents the latest attempt to leverage the scale of a multi-state hospital system
New England Journal of Medicine Catalyst: (5/9) – Numerous new models of primary care financing and delivery are rapidly arising throughout the country, and some see this as a possible savior for primary care. But, in many ways, these changes could either fail to meet the hype around them, or in some cases even hasten the end of the independent primary care practices that once dominated the physician landscape. The authors develop a typology of new innovative primary care organizations — spanning comprehensive care providers, limited-service providers, and value-based care enablers — to provide a useful conceptual framework for classifying these emerging approaches along relevant dimensions and characteristics.