Welcome to this week's edition of the 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: (12/21) - CMS finalized a rule to modernize Medicaid prescription drug purchasing and encourage payment innovation by providing states, private payers, and manufacturers more flexibility to enter into value-based purchasing arrangements for prescription drugs.
CMS: (12/18) – CMMI released the first evaluation report for Performance Years 1-3 of the Accountable Health Communities (AHC) Model. The findings suggest the AHC model is effectively identifying higher cost and utilization beneficiaries. Over half of navigation-eligible beneficiaries reported more than one core need, and 74 percent of eligible beneficiaries accepted navigation to address health-related social needs (HRSNs) although effectiveness in resolving HRSNs was low during early stages of implementation. Early results show a 9 percent reduction in ED visits among Medicare FFS enrollees, but no Medicare savings or impacts on other outcomes in the first year. The full evaluation report can be found here.
CMS: (12/17) - CMS announced the MCO-based Direct Contracting Entity (DCE) type for the Direct Contracting Model. Under Direct Contracting, participating MCO-based DCEs will have new incentives to provide whole-person care and better serve their full-benefit dually eligible enrollees. MCO-based DCEs will begin participating in the model in January 2022.
HHS: (12/16) - HHS announced it will distribute $24.5 billion from the Provider Relief Fund to over 70,000 providers. Payment distribution started December 16 and will continue through January, 2021. A state-by-state breakdown on the first batch of Phase 3 payments will be updated through January as Phase 3 payments are completed.
CMS Office of the Actuary: (12/16) - CMS Office of the Actuary released 2019 national health expenditure data, including spending data on private health insurance, Medicare, and Medicaid spending. The total national healthcare spending in 2019 grew 4.6 percent which was similar to the 4.7 percent growth in 2018 and the average annual growth since 2016 of 4.5 percent. Medicare spending grew the fastest of all of the insurance markets, and the growth in spending is attributed to Medicare private health plan spending.
CMS: (12/15) - CMS posted frequently asked questions (FAQs) for the Community Transformation Track for the Community Health Access and Rural Transformation (CHART) Model. Optional letters of intent (LOIs) are due by January 12.
Senate Appropriations Committee: (12/21) - Congress passed the end-of-year appropriations package, including fiscal 2021 appropriations, healthcare extenders and COVID relief provisions. The package and associated report language include:
Public Health and Social Services Emergency Fund -$3 billion added to remain available until expended, to prevent, prepare for, and respond to coronavirus, domestically or internationally, which shall be for necessary expenses to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus (page 1849).
Supporting Physicians and Other Professionals in Adjusting to Medicare Payment Changes During 2021 - Provides for a one-time, one-year increase in the Medicare fee schedule of 3.75 percent, to support physicians and other professionals in adjusting to changes in the Medicare fee schedule during 2021 and to provide relief during the public health emergency (page 1924).
Moratorium on payment under the Medicare physician fee schedule of the add-on code for inherently complex evaluation and management visits- Prohibits the Secretary of the Department of Health and Human Services (HHS) from making payments under the Physician Fee Schedule for services described by Healthcare Common Procedure Coding System (HCPCS) code G2211 (or any successor or substantially similar code) prior to January 1, 2024 (Page 4620).
Temporary freeze of APM payment incentive thresholds - Freezes the current payment and patient count thresholds for physicians and other eligible clinicians participating in Advanced Alternative Payment Models (APMs) to receive a five percent incentive payment in payment years 2023 and 2024 (performance years 2021 and 2022). It also freezes the Partial Qualifying APM participant payment and patient count thresholds at current levels for payment years 2023 and 2024 (performance years 2021 and 2022)(Page 4621).
Rep. Smith: (12/18) - Reps. Smith (R-MO) and Cardenas (D-CA) introduced the Permanency for Audio-Only Telehealth Act (H.R. 9035), which would expand access to certain telehealth services under the Medicare program.
Rep. Beyer: (12/15) - Rep. Beyer (D-VA) introduced the Federal All-Payer Claims Database Act (H.R. 8967), which would require the Secretary of HHS to award a contract to an eligible nonprofit entity to establish and maintain a health care claims database for purposes of lowering American’s health care costs.
Aledade: (12/21) - Sean Cavanaugh, Chief Policy Officer and Chief Commercial Officer of Aledade, provides an overview of the history of telehealth and argues that while the health care system is not designed to support telehealth, the move towards value-based care should link telehealth waivers to payment reforms, which could drive greater uptake of those models and prevent overutilization.
BizJournals: (12/21) - Aledade has announced a new partnership with Regence BlueShield to provide primary care for rural communities in the Pacific Northwest, helping providers transition to a value-based care model.
Health Affairs: (12/18) - In this blog, several thought leaders in the health care sector, including Aledade CEO Farzad Mostashari, outlined how COVID-19 has highlighted the scope and scale of shifts in the health care delivery system that can be achieved. The authors emphasized the need for CMMI to consolidate and institutionalize these shifts to strategically test and scale new payment models to achieve permanent changes in Medicare payment policy based on targeted CMMI models that generate financial savings, and enhanced health care equity through Medicare and Medicaid. The article outlines core priorities for achieving these goals and a comprehensive table to outline major recommendations.
CMA: (December) - California Medical Association compiled a COVID-19 vaccine resource page for physicians to follow the latest information on vaccine-related news, including the latest information from California state officials and FAQ’s.
Business Insider: (12/22) - The convergence of COVID-19 and the CMS interoperability rule has accelerated interoperability in health care, as evidenced by major insurance companies investing in health data-sharing startups like Centene’s funding of Diameter Health. Such interoperability initiatives are key to a widespread shift to value-based care and can contribute to a more sustainable VBC model.
Modern Healthcare: (12/21) - Innovative value-based payment agreements are key to addressing unmet health needs and moving toward a health care system centered on improved patient outcomes and reduced medical spending. In this article, Boehringer Ingelheim outlines its views on value-based agreements and how such agreements play an important role in addressing uncertainty, tracking real-world outcomes, building on foundational clinical safety and efficacy trials to assess real-world value, and pushing the pharmaceutical industry to invest more to ensure products address clinical and societal needs.
Healio: (12/21) - New data revealed that hospitals enrolled in the Medicare Bundled Payments for Care Improvement (BPCI) program saved 2 percent for each major hip or knee replacement compared with hospitals that were not enrolled in the program. To examine this further, a study published in the Annals of Internal Medicine examined whether hospitals and clinicians responded to incentives under bundled payments by redesigning care for all patients.
Delaware.gov: (12/21) - A new report, titled “Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality, and Value,” includes the State of Delaware’s plans to strengthen primary care in the state by doubling primary care spending in the commercial market by 2025.
Fierce Healthcare: (12/18) - NAACOS wrote a letter to CMMI calling for a halt to the new Geographic Direct Contracting model, citing concerns for its potential to add confusion and complexity for beneficiaries compelled to participate in the model. NAACOS offered several policy recommendations to CMMI on the matter, including fixing existing model overlap issues rather than creating a new layer of complexity with this model.
Modern Healthcare: (12/18) - Digital health resources have been a valuable bridge connecting providers and patients during the COVID-19 pandemic. Investing in virtual care capabilities to improve patient access to care could help practices to progress through the continuum of value-based care and encourage success in risk-based contracts.
JAMA Network: (12/18) - A new analysis published in JAMA looked at both the problems and successes observed with the transition to value-based payments (VBP), outlining how early efforts at outpatient VBP, especially with MIPS, have not met their goals. The article outlines possible changes that can be made to make meaningful improvements to clinician payment in Medicare by building on the success of MSSP, MA, and the Alternative Quality Contract to replace the current system.
Healthcare IT News: (12/17) - A recent study by Medical Care analyzed primary care exam lengths using electronic health record (EHR) time stamps. The study found that the average exam time lasted 1.2 minutes longer than scheduled, suggesting inefficiencies with scheduling logistics and within the EHR itself.
Fierce Healthcare: (12/17) - The Sequoia Project launched an initiative to help providers, health IT developers, and health information exchanges get into compliance with final rules around interoperability and information blocking. The Interoperability Matters initiative includes three community subgroups to reflect issues facing stakeholders and other communities affected by these rules to help them address operational issues and best practices.
Fierce Healthcare: (12/16) - A new analysis from PwC found that hospitals and health systems that have health plans or value-based care arrangements will be better positioned to cushion financial fallout from COVID-19 moving into 2021. The analysis reveals that providers will likely face uneven recovery, and that systems that heavily invested in value-based arrangements have fared better.
Health Payer Intelligence: (12/16) - While the transition to value-based care has been a slow process for some health payers, plans such as Blue Cross and Blue Shield of North Carolina (Blue Cross NC) have used its programs to advance value-based arrangements. Blue Cross NC launched its Blue Premier program in 2019 and has achieved 52 percent membership in value-based care arrangements as of mid-December 2020. The health plan pointed to its partnerships with providers that enabled the payer to make this rapid shift.
Revcycle Intelligence: (12/16) - Hundreds of medical organizations and lawmakers are pushing Congress to stop rate reductions to the Medicare Physician Fee Schedule that are set to begin January 1, 2021. While payment rates increased for many primary care services, over one million health care providers are being faced with payment cuts as high as 10 percent due to budget neutrality requirements in the rule. As several providers have been working on the frontlines of the pandemic, these groups pushed for Congress to #StopTheCuts as part of the year-end legislative package to support providers.
Health Care Payment Learning & Action Network: (12/16) - HCP LAN released the LAN Healthcare Resiliency Framework, describing key actions that payers, providers, and multi-stakeholder groups can take in the short-and long-term to promote more resilient and effective APMs.
Patient Engagement HIT: (12/15) - Steward Medical Group was able to meet patient needs during the pandemic by having a targeted telehealth and patient care access plan. This article outlines the experience of Stephany Godfrey, DO, a family physician with Steward Medical Group who practices in Boston. Godfrey says the actions taken by her practice to have such mechanisms in place allowed her to feel more prepared in addressing the current wave of COVID-19 cases.
Partnership to Empower Physician-Led Care
1100 H Street, Washington District of Columbia 20005 United States
You received this email because you signed up on our website or attended one of our events.