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.
(7/26) – CMS unveiled its Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period, including policies to support a diverse provider workforce.
HHS: (7/25) - HHS announced a proposed rule implementing Section 1557 of the Affordable Care Act (ACA) that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. This proposed rule restores and strengthens civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the 2020 version of the rule limited its scope and power to cover fewer programs and services. Fact Sheet
HHS: (7/22) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report discussing disparities in health and health care experienced by American Indian and Alaska Native (AI/AN) populations, the role of the federal government in financing and providing health care services to these populations, and how enhanced funding could ensure that tribal communities have access to high quality health care services.
CMS: (7/21) - CMS officials penned a blog, published in Health Affairs, regarding its efforts in Medicare to transition the health care system towards value-based care, highlighting the CMS Innovation Center strategy refresh, vision for Medicare, and National Quality Strategy as key elements of this goal. This article builds off these publications to outline a cohesive Value-Based Care Strategy for Medicare along three pillars: alignment, growth, and equity.
CMS: (7/20) - CMS released a white paper which examined evaluation results - including utilization, quality, and cost metrics – across the portfolio of CMS Innovation Center models to inform future model development. CMS examined 21 Medicare models and demonstrations with at least two years of impact estimates that cover interventions operating between 2012 and 2020 to gain a broader understanding of themes by interventions, care settings, provider types, and beneficiary target populations. More than half (14) of models demonstrated gross savings to Medicare. Supplemental Document
Sen. Klobuchar: (7/21) – Following the announcement that Amazon would purchase membership-based primary care practice One Medical, Sen. Klobuchar (D-MN) urged the Federal Trade Commission (FTC) to investigate this proposed acquisition and its potential impact on anticompetitive practices in the health care sector.
MGMA: (7/26) – Medical Group Management Association (MGMA) released a new report detailing the significant challenges facing health systems, medical practices, and hospitals due to inflation, rising expenses, and staffing shortages. MGMA created a data report that includes key findings on the ongoing impacts of productivity gaps compared to pre-pandemic benchmarks, uneven financial recoveries of physician-owned and hospital-owned practices, trends in total medical revenue by ownership and specialty type, increases in operating expenses, and declines in staffing levels.
Purchaser Business Group on Health: (7/26) – As part of a new multi-stakeholder initiative, six health care organizations serving California, including Aledade, have signed a memorandum of understanding (MOU) to increase investment in and access to advanced primary care. The agreement outlines a new initiative that strengthens the primary care delivery system throughout the state by enabling primary care practices to transform to a high-performing, value-based care model that reduces costs and improves quality and equity.
Aledade: (7/22) – Aledade’s Senior Vice President for Policy & Economics, Travis Broome, hosted a webinar on what the CMS CY2023 Physician Fee Schedule proposed rule means for the thousands of independent primary care practices, clinics, and health centers in Aledade ACOs, as well as for physicians across the country. This blog focuses on the proposed changes to the Medicare Shared Savings Program (MSSP) contained in the proposal, with a short summary of some of the non-related MSSP-related proposals.
Journal of the Medical Care Section, American Public Health Association: (7/26) - Medicaid expansion has increased health care utilization by low-income Americans. Emerging studies have found that expansion changed the geographical distribution of new physicians. However, the effect of expansion on physician compensation has not been studied. This study aimed to assess how Medicaid expansion has affected the compensation of new primary care physicians and whether the effect differed by specialty, gender, and geography.
Bloomberg Law: (7/26) – The proposed 2023 Medicare Physician Fee Schedule rule, if finalized, would provide new financial and programmatic incentives for health care providers to form or join accountable care organizations (ACOs). It would also remove barriers to ACO creation among smaller providers that mainly serve underrepresented populations. The proposal would also add an equity adjustment to an ACO’s quality performance score to reward quality care delivered to underserved populations, which would be one of the first efforts to promote equity in a value-based care program.
STAT News: (7/26) – The authors of this op-ed argue that it is time for proponents of value-based care to call for a pause on such programs until the following question is answered: “Why have the vast majority of value-based payment experiments failed to improve value?” The authors note four possible explanations to this question, including wrong diagnosis, no definition of what an ACO is expected to do, requiring that ACO members be assigned rather than enroll, and no evidence for assumption that price and quality can be accurately measured.
California Health Care Foundation: (7/25) – Primary care is the only component of health care for which an increased supply is associated with better population health, longer lives, and improved health equity. Few data were available on the level of primary care investment within Medi-Cal, California’s health program for those with low incomes. This study examines primary care spending by 13 Medi-Cal managed care plans, covering 5.4 million members, and finds that greater investment in primary care is associated with better quality of care and a higher plan rating.
MedCity News: (7/25) – The move to value-based care (VBC) has yielded positive results in primary care, and there are emerging alternative payment models in specialty care for other chronic conditions. This article asks the question: if payers are ready to turn their attention to value-based care in behavioral health, and invite behavioral health providers into the room – are providers ready to enter and fully participate in VBC? Payers should provide the support and investment required, and providers should willingly step into value-based care.
Brookings Institution: (7/25) – In The Roadmap to Telehealth Efficacy report, Brookings Institution proposes flexibilities within the current health care system that accommodate the changes imposed by new technologies, as well as continued government incentives to drive more competitive options and alternatives for health care delivery. Notably, the report argues that telehealth must be positioned and implemented in coordination with value-based payments to ensure patient access to meaningful care that can be bolstered and not substituted by existing and emerging health care technologies.
Medical Economics: (7/25) – Health care technology has largely failed to deliver on its promise to make the management of patient care simpler, easier, and less stressful for clinicians. Although technology hasn’t improved efficiency to the extent promised, tech that empowers smaller, independent practices to not only stay viable but to succeed in shared initiatives, such as value-based care models, can help preserve independent practices and general practitioners.
STAT News: (7/23) – Amazon recently announced its plan to acquire primary care provider One Medical. The authors of this blog, all primary care physicians, note that the proposed acquisition has significant implications for the future of primary care, health care delivery, and health equity. For primary care that is accessible to all to compete with companies like Amazon, it will be necessary to pay more for primary care by doubling investment in it while moving away from the fee-for-service system that perpetuates inequities across medical specialties.
Center for Medicare Advocacy: (7/21) – In its “A Year in Review June 2021-May 2022,” CMS cites the introduction of the ACO Realizing Equity, Access, and Community Health (REACH) model as a key accomplishment in achieving its strategic initiatives. CMS explains that the “ACO REACH model will test an innovative payment approach to better support care delivery and coordination for patients in underserved communities.” This article explores the differences between the ACO REACH model compared to traditional value-based payment models.
STAT News: (7/19) – As value-based payment reform expands, implementing the necessary changes to enable it must operate from a frame of equity rather than equality. Some payers and policymakers who are shifting to value-based reimbursement remain stuck in an equality mindset, treating all health systems the same rather than recognizing the disparate starting points for this transition, which can curtail progress toward a truly equitable health care environment.