Newsletter for Members and Partners February 01, 2024
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SIGN UP FOR THE NAACOS 2024 SPRING HILL DAY
Want to make your voice heard in Washington and advocate for policies that benefit ACOs? Join the NAACOS Spring Hill Day on Wednesday, April 10 in conjunction with our spring conference. NAACOS staff will coordinate travel between Baltimore and Washington, D.C., for those attending the conference. Registration is open until March 1. If you have questions, contact Robert Daley.
MEDICARE ACOS GROW IN 2024, NAACOS CALLS FOR MORE WORK BY CMS
This week CMS released information on the 2024 participants in MSSP and ACO REACH. More Medicare patients than ever are being cared for by ACOs with 122 REACH ACOs caring for 2.6 million people and 480 MSSP ACOs caring for 10.8 million people. Other highlights include:
- ACO REACH:
- ACO REACH grew by 25 percent this year to now serve 2.6 million people.
- There are 104 Standard, 4 New Entrant, and 14 High Needs REACH ACOs.
- 103 REACH ACOs elected global risk and 19 chose professional risk.
- MSSP:
- Two-thirds of MSSP are in two-sided risk with the Enhanced Track accounting for almost half of MSSP (43 percent).
- There are more than 608,000 physicians and non-physician clinicians, 1,466 acute care hospitals, and 513 critical access hospitals in these ACOs.
NEW PATIENT STORIES FROM THE ALLIANCE FOR VALUE-BASED PATIENT CARE
Check out the Alliance for Value-Based Patient Care‘s recently published patient stories featuring Summit Health in New Jersey and Novant Health in North Carolina. These stories demonstrate the power of care coordination and chronic disease management. We need to continue highlighting patient stories. Submit any stories from your organization or contact David Pittman for more information.
Follow the Alliance on LinkedIn and Twitter. NEW NAACOS RESOURCES AVAILABLE
- GUIDE Resource. Applications for the CMS Innovation Center’s new Guiding an Improved Dementia Experience (GUIDE) Model for dementia care were due earlier this week. Many ACOs have considered the model and balancing the enhanced benefits for beneficiaries with the care management and respite fees that will count to an ACOs expenditures. NAACOS will be developing recommendations on how to better align GUIDE and ACO models. Contact us if you have feedback.
- Prior Authorization Final Rule Summary
- MSSP Quality Reporting and Scoring Resources
| CONGRESSIONAL UPDATES |
LAWMAKERS LOOK FOR AGREEMENT ON GOVERNMENT FUNDING
While Congress has agreed on the broad terms of a government funding proposal, the details of the package are still being negotiated. Lawmakers hope to have an agreement prior to the next government funding deadline on March 1. Members of the House Doctors Caucus are calling on congressional leaders to prioritize addressing the 3.4 percent cut to Medicare reimbursements that went into place on January 1. Value-based care champions are also pushing for an extension of the advanced APM incentive payments.
NAACOS CO-HOSTED CONGRESSIONAL BRIEFING ON HEALTH CARE VALUE
NAACOS and our partners in the Alliance for Value-Based Patient Care hosted an educational briefing for congressional staff during Health Care Value Week. The briefing featured insights from leading value-based care stakeholders and clinicians about the benefits of transitioning to alternative payment models, how Congress has supported these initiatives, and how Congress can continue to support and strengthen this transformative movement. The Alliance called on Congress to extend advanced APM incentive payments, develop solutions to improve physician payment, and support the Value in Health Care Act.
NAACOS’ Senior Vice President of Government Affairs, Aisha Pittman, kicks off the briefing with Representative Darin LaHood (R-IL), the lead sponsor of the Value in Health Care Act.
| ADMINISTRATION UPDATES |
FINAL PRIOR AUTHORIZATION RULE RELEASED
On January 17, CMS finalized the CMS Interoperability and Prior Authorization final rule. This rule sets requirements for Medicare Advantage (MA), state Medicaid and CHIP fee for service and managed care plans, and Qualified Health Plans on the Federally Facilitated Exchanges to improve the prior authorization process. The CMS fact sheet is available. Beginning in 2026, affected plans would need to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests. The rule also requires in January 2027, implementation of HL7 Fast Healthcare Interoperability Resources (FHIR) Prior Authorization application programming interface (API), which can be used to facilitate a more efficient electronic prior authorization exchange.
Other key points in the rule include:
- Requirements for affected plans to expand their current patient access API to include information about prior authorizations and add functionality to retrieve patients’ claims, encounter, clinical and prior authorization data.
- Adding new measures in the Merit-Based Incentive Payment System (MIPS) and Hospital Promoting Interoperability Program to encourage providers to adopt electronic prior authorization processes.
NAACOS has developed a summary of key points included in the rule.
NEW QUALITY RESOURCES FOR MSSP ACOSCMS recently published a new resource for MSSP ACOs providing the Quality Performance Standard amount for Performance Year (PY) 2024. The Quality Performance Standard is the score MSSP ACOs must meet or exceed to be eligible to share in savings at the maximum shared savings rate; the score for PY 2024 is 77.05. In the final 2024 Medicare Physician Fee Schedule (MPFS) rule, CMS moved to using historic performance to establish the Quality Performance Standard amount. CMS now looks at historic performance to establish the three-year average score with a lag of one performance year. For PY 2024 the Quality Performance Standard was based on averaging the 40th percentile MIPS Quality Performance Category scores from PY 202 through PY 2022. NAACOS has also developed two new resources to assist ACOs in understating quality reporting and scoring requirements for MSSP for 2024.
BPCI ADVANCED MODEL YEAR 7 PARTICIPANTS POSTED
Bundled Payments for Care Improvement Advanced (BPCI Advanced) began Model Year 7, with a list of new participants now posted on the Innovation Center website along with service line group selections (see BPCI-A Participant Lists). For 2024, there are 108 new participants and 99 continuing participants. The top five selected clinical episode service line groups include cardiac care, medical and critical care, orthopedics, gastrointestinal care, and neurological care. The model was initially scheduled to conclude in December 2023, but it was extended for two additional years and now ends in December 2025.
TEFCA MATERIALS UPDATED
The Trusted Exchange Framework and Common Agreement (TEFCA) Recognized Coordinating Entity, The Sequoia Project, released new draft TEFCA materials to support greater use of HL7 FHIR. A webinar series will be provided for additional education. The new resources and other educational resources are available.
CMS RELEASES MA PAYMENT UPDATES FOR 2025 AND RFI ON DATA SHARING AND TRANSPARENCY
Yesterday, CMS released the CY 2025 Advance Notice for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs. MA payments from the government to MA plans are expected to increase on average by 3.70 percent, or over $16 billion, from 2024 to 2025. Additionally, CMS is proposing to continue the three-year phase-in of the new risk adjustment model. The rate notice also includes Part D benefit-related Inflation Reduction Act (IRA) updates that will be in place for CY 2025. The Part D Redesign Program fact sheet provides information on the elimination of the coverage gap phase to affect a three-phase benefit (deductible, initial coverage, and catastrophic) and cap out-of-pocket costs at $2,000 for CY 2025.
Last week, CMS released a request for information seeking feedback on how to improve data sharing and transparency in Medicare Advantage. CMS calls for ways to collect and release more MA data on supplemental benefit costs and utilization, value-based payment arrangements between providers and plans, utilization management and prior authorization, network adequacy and provider directory accuracy, competitive forces such as the effects of vertical integration and consolidation on consumers and care. Comments are due on May 29.
NEW CMS INNOVATION CENTER MODEL TO FOCUS ON BEHAVIORAL HEALTH INTEGRATION
The Innovation in Behavioral Health Model is a new state-based model recently released by the CMS Innovation Center. It hopes to better integrate physical and behavioral health care by aligning payment between Medicaid, Medicare, and social supports. Community-based behavioral health practices would form care teams with community-based support. Additional details on how states can participate will be available in the coming months. More information can be found in the press release.
| EDUCATION OPPORTUNITIES |
BOOT CAMPS FOR 2024 ARE NEXT WEEK!
Join us February 8–9 at the Marriott Orlando Airport Lakeside for two concurrent boot camps that teach ACOs how to succeed in key functional areas. One focuses on data and analytics, sponsored by Wakely and Diagnostic Robotics, and the other on best practices for clinical operations, sponsored by Brilliant Care and iRhythm. Participants must register for one boot camp and may attend only that one. Daily lunches and a reception will be held jointly so that attendees at both boot camps may benefit from increased networking opportunities. **These boot camps are only offered for in-person participation. There will be no virtual option. Boot camps are not open to business partners. Space is limited to 100 people per boot camp.** NAACOS typically holds a winter and a summer boot camp but will not be holding a summer boot camp this year. Don’t miss out! Register now! Still in need of a hotel room? To book a room through NAACOS, you must contact Richard Enderica at the Marriott directly at 407-816-4026.
SPRING 2024 CONFERENCE IS JUST AROUND THE CORNER!
Meet us at the Baltimore Hilton Inner Harbor on April 10–12 for the Spring 2024 Conference! The detailed agenda will feature leading health care experts and CMS officials sharing timely and essential information for ACOs. Registration is now open for both in-person and virtual participation. Member ACOs get an additional discount when they register groups of individuals. More information can be found on our website. Register early and save!
Sponsor and exhibit opportunities for the Spring 2024 Conference are selling out! Reserve your space today!
WEBINAR TODAY ON ACO USE OF MEDICARE SHADOW BUNDLES
Join us today from 4:00–5:00 pm ET as we delve into the world of Medicare Shadow Bundles: How Can ACOs Use Them? The CMS Innovation Center plans to share episode spending data with ACOs in the coming months as part of its strategy to promote value-based specialty care. NAACOS has already provided summary episode spending reports to its members. This webinar will discuss how to use your episode spending reports that show BPCI-Advanced episodes triggered by ACO attributed beneficiaries. ACO executives Bob Rauner, OneHealth Nebraska, and Arshad Rahim, Mount Sinai Health System, will discuss how they have used the reports, including the use of enhanced data with more detail that goes beyond the ACO. We will also discuss potential, future CMS bundled payment policies and how they would affect ACOs. Participant questions and feedback is encouraged. This webinar is free for NAACOS members, and non-members pay a fee of $195. Register Now!
Download your NAACOS episode spending report.
NAACOS UPDATES 2024 MSSP AND REACH COMPLIANCE MANUALS
NAACOS has partnered with Wilems Resource Group to offer MSSP and REACH ACOs Compliance Manuals with a robust set of policies and procedures that your organization can customize to meet individual needs. Why should you purchase the manual? ACOs are required to meet a large number of state and federal regulatory requirements, including health care fraud and abuse laws, privacy requirements, and the specific requirements of CMS. These manuals include the necessary tools designed to provide template policies to help your leadership determine the best “next steps” for your organization and implement procedures to ensure compliance with program requirements. Purchase or renew your subscription today!
START THE NEW YEAR RIGHT WITH ACO COMPLIANCE WEBINARS
Did you set a New Year’s Resolution to stay on top of your ACO’s compliance requirements? Should you? Absolutely! Join us for the webinar, New Years Resolution: Prepping for ACO Compliance in PY24, as we walk through the steps you need to take now to ensure you are prepared for compliance success in PY24, including:
- Document Review and Approval
- Recommended and Necessary Updates for Regulatory Changes
- Compliance Program Planning and How to Build a Monitoring Plan
REACH Webinar: February 28, 2:00–3:00 pm ET
Speaker: Kim Busenbark, Wilems Resource Group
AFFINITY GROUP WINTER SESSIONS GET UNDERWAY
Are you signed up? NAACOS offers six peer-to-peer affinity groups categorized by ACO role, which meet virtually. You may join one or more than that align with your current roles and responsibilities. You will need to sign up one time for each group that you would like to participate in. Once you have signed up, you will receive the Zoom log-in information for these virtual meetings which you must add to your own calendar. We will send reminders 4 weeks before each session so if you register after this, you will not be sent a reminder appointment. This why it is important to add the first meeting with the zoon link to your own calendar.
MARCH 7 DISCOVERY CALL ON USING MSSP BENCHMARK TOOL WITH Q4 FILE
With the upcoming release of the QEXPU for the Fourth Quarter of 2023, MSSP ACOs will be challenged to forecast their PY 2023 performance. Join us for a discovery call on March 7 at 2:00 pm ET with Andrew Webster, ASA, MAAA, Chief Actuary at Validate Health and actuarial advisor to NAACOS. We will cover the basics of applying your Q4 files to this tool, sensitivity of forecast accuracy to input value variations, considerations for the end of the COVID PHE, and methods to improve forecast usefulness. After a brief presentation, we will have an interactive discussion, where attendees can share their own experience and challenges with using the tool as well as pick up tips from peers.
| WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE |
- The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) published an updated data book: Beneficiaries Dually Eligible for Medicare and Medicaid with key data on this population, costs and utilization, and overlap in Medicaid and Medicare managed care enrollment.
- In Health Affairs Forefront, authors discuss the intersection between advancing value-based care and strengthening primary care, and they recommend evaluations that go beyond cost reductions to assess whether models enable care delivery transformation that improves outcomes, advances equity, and attracts more primary care clinicians.
- The House Energy and Commerce Health Subcommittee held a hearing this week to discuss health care spending and how to improve the health care system for patients, employers, and taxpayers. NAACOS will be submitting comments to the committee highlighting how ACOs improve quality and lower costs.