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.
Assistant Secretary for Planning and Evaluation (ASPE): (9/10) – The Department of Health and Human Services (HHS) released a report on air ambulance use and surprise billing, providing evidence on the number of air ambulance providers and suppliers, utilization rates by patients, and average costs, as well as the potential for balance billing for air ambulance transport, particularly for privately insured and uninsured patients.
HHS: (9/10) – HHS announced the availability of $25.5 billion in COVID-19 provider relief funding. This includes $8.5 billion in American Rescue Plan resources for providers who serve rural Medicaid, CHIP or Medicare patients, and $17 billion for Provider Relief Phase 4 for a broad range of providers.
White House: (9/10) – On Friday, the White House Competition Council held its inaugural meeting. The Council’s members – including eight cabinet members and the leaders of seven independent agencies – met to discuss the actions they are taking to help lower prices for American families by boosting competition and to plan the group’s priorities over the coming months. For Healthcare, the Council touts three plans including the drug pricing plan that was released last week.
Office of the Assistant Secretary for Planning and Evaluation (ASPE): (9/9) – HHS released their Comprehensive Plan For Addressing High Drug Prices in response to the Competition Executive Order that President Biden issued July 9, 2021. The Report identifies three guiding principles for the Drug Pricing Plan: make drug prices more affordable and equitable throughout the system, promote competition in the prescription drug industry and foster scientific innovation to improve health outcomes. In addition, the Report says the Center for Medicare & Medicaid Innovation can create small-scale mandatory models that could link payments for drugs and biologics to metrics that include improved patient outcomes and lower overall cost.
CMS: (9/9) – CMS Administrator Brooks-LaSure penned a blog post highlighting her actions during her first 100 days, and her strategic vision for CMS moving forward.
White House: (9/9) – On September 9, President Biden delivered remarks to announce the White House’s “Path Out of the Pandemic” COVID-19 Action Plan, a six-pronged national strategy to combat COVID-19 in the months ahead. President Biden also signed two executive orders, one on ensuring adequate COVID safety protocols for federal contractors, and another that will require COVID vaccinations for federal employees.
CMS: (9/7) – CMS issued the fourth annual report for the Comprehensive Care for Joint Replacement (CJR) model, finding that participant hospitals achieved reductions in episode payments relative to the control group and that overall, measures of quality of care improved or were maintained.
Rep. Fletcher (D-TX): (9/10) – Reps. Fletcher (D-TX) and Herrera Beutler (R-WA) introduced the Collaborate in an Orderly and Cohesive Manner (COCM) Act (H.R. 5218), which would increase uptake of the Collaborative Care Model.
House Energy and Commerce Committee: (9/9) – On September 9, the House Energy and Commerce committee released bill text and a section-by-section for its portion of the reconciliation package. Specifically, the Committee released proposals related to prescription drug pricing, ACA subsidies, Medicaid coverage gap, CHIP, Medicare dental, vision and hearing benefits, and public health, among other provisions.
American Journal of Managed Care (AJMC): (9/14) – Aledade staff conducted a retrospective study of a cohort of accountable care organizations (ACOs) that achieved success relative to their programmatic benchmarks in the Medicare Shared Savings Program (MSSP). The authors sought to evaluate the impact of those ACOs relative to local trends on cost of care, inpatient utilization, the use of primary care services, and quality of care. They found that although it takes time to achieve results, value-based care has the potential to meaningfully reduce costs and improve the quality of care delivered by increasing preventive care and reducing utilization of acute services.
American Academy of Family Physicians: (9/13) – AAFP sent a letter to President Biden sharing their recommendations for how the Administration can support primary care physicians and practices in their ongoing efforts to protect their patients and communities from COVID-19.
AAFP: (9/9) – In a letter this month to CMS, AAFP expressed strong support for patient protections in a recent interim final rule related to surprise billing, but called for sharper focus on administrative simplification. The letter flagged the interim final rule’s treatment of alternative payment models and the notice-and-consent process as potential burdens to primary care practices.
Medical Group Management Associates (MGMA): (9/8) – MGMA as a part of the Graduate Medical Education (GME) Advocacy Coalition wrote a letter to Chairmen Wyden and Neal, and Ranking Members Crapo and Brady to urge Congress to increase Medicare support for GME.
Florida Medical Association: (9/10) – A Kaiser Family Foundation study found that Florida is now one of the only two states in the nation wherein the majority of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans. Jarrod Fowler of Florida Medical Association details what this means for the Medicare program and what changes in regulation are needed to accommodate this shift.
Health Affairs: (9/14) – Leemore Dafny from the Harvard Business School and Harvard Kennedy School joins Health Affairs Editor-in-Chief Alan Weil to discuss her latest research on hospital prices and market concentration. Dafny and colleagues published a paper in the September 2021 issue of Health Affairs analyzing hospital prices and relating them to market concentration. The authors found the relationship isn't as straightforward as one might expect — but the findings still have major implications for any consideration of regulating hospital prices.
AJMC: (9/14) – In this article, authors found there has been a plateau in the number of ACOs since 2018, with ACO exits outweighing entrants for the past two years. They wrote that physician-led ACOs were more likely than other types of ACOs to leave the program. These lower entrance and survival rates are a problem for the ACO movement given the positive shared savings and quality results that many physician group–led ACOs have been able to achieve.
Fierce Healthcare: (9/13) – Policymakers have introduced proposals to combat high and rising hospital prices, but focusing on high-concentration markets likely misses the mark. The majority of high-price hospitals are active in markets that meet federal definitions of low or moderate concentration, according to a recently published commercial claims review.
Health Affairs: (September 2021) – Authors including Michael Chernew and Leemore Dafny found that most high-price hospitals are in markets that would be deemed competitive or “moderately concentrated,” using antitrust guidelines. They argue that limiting policy actions to concentrated hospital markets, particularly when those markets are defined broadly, would likely result in poor targeting of high-price hospitals. Policies that target the undesired outcome of high price directly, whether as a trigger or as a screen for action, are likely to be more effective than those that limit action based on market concentration.
Morning Consult: (9/10) – Early action from the Administration points to hospital price transparency and heightened merger scrutiny as top priorities. President Biden laid out his broad antitrust agenda in an executive order in July that singled out rural hospital closures and higher hospital prices in markets with little competition as reasons to support stronger Federal Trade Commission (FTC) guidelines for healthcare mergers. As a result, the FTC appears to be taking more time to review details on proposed mergers that may have otherwise been cleared quickly or seen as “non-problematic.”
Healthcare Finance News: (9/10) – PEPC joined 16 other national healthcare organizations in urging Department of Health and Human Services Secretary Xavier Becerra to move forward on alternative payment models as part of its strategy to achieve health equity. In a letter sent to Becerra, the groups underscored how APMs routinely leverage multidisciplinary approaches to care, assess social risk, partner with community organizations to increase access to nonmedical services and leverage data to improve disparities in patient outcomes.
MedCity News: (9/9) – In a recent survey, approximately 75 percent of employers said they plan to ramp up their implementation of value-based care models over the next three years, with many indicating they are exploring virtual care partnerships. Other goals include: Match members with experts best suited to their medical needs—and not just locally; Deliver faster, more efficient care, along with improved patient experiences; and Reduce disparities in care that affect ethnic and social minorities.
Fierce Healthcare: (9/9) – The Department of Health and Human Services (HHS) wants to test models that would pay drugs based on their clinical value as part of a new plan to tackle high prices.The plan lays out several administrative tools the agency plans to take to address high prices. It also calls on Congress to adopt several reforms such as giving Medicare price negotiation authority and cap Part D catastrophic spending.
Managed Healthcare Executive: (9/8) – To reduce the cost of care and improve health outcomes for their members, the authors argue payers will have to take a more active approach to value-based care by leveraging data to find targeted opportunities, collaborating with providers, and supporting investment in medical technology.
Modern Healthcare: (9/8) – The Centers for Medicare and Medicaid Services will turn a skeptical eye toward venture capital and private equity investments in healthcare and demand greater transparency, a key agency official said Wednesday. Pauline Lapin, director of the Center for Medicaid and Medicaid Innovation's Seamless Care Models Group, said Officials worry patients won't get the care they need if investors are only in healthcare to collect government money.