Congress Must Act to Support Value-Based Patient Care
Value-based care is how many providers choose to deliver care to their patients. It supports better coordination, improved outcomes, and the flexibility to offer additional services patients need. It also helps address cash flow challenges by providing more predictable, stable payments. As more providers transition into value-based payment models, the results are clear— clinicians are providing better care, keeping patients healthier, and lowering costs. To build on this progress, continued support from policymakers is needed to strengthen these innovative programs.
Continue to Incent APM Adoption
Medicare’s advanced alternative payment model (AAPM) incentive payments encourage clinicians to join and remain in risk-based models and support enhanced services that are used to help improve patient outcomes.
Congress should extend AAPM incentive payments to encourage continued adoption of value-based payment models; and
Adjust qualifying thresholds so clinicians are not involuntarily forced back into the Merit-based Payment System (MIPS).
Promote Sustainability of the Models
Value-based care models like the Medicare Shared Savings Program (MSSP) have improved outcomes and lowered costs. CMS Innovation Center models, like Direct Contracting and ACO REACH, have tested approaches to care. Long-term sustainability of these models is essential.
Congress can support providers in value-based care models by:
- Creating more sustainability and innovation within current models — including by extending ACO REACH and removing the Accountable Care Prospective Trend from MSSP;
- Reducing regulatory burdens; and
- Partnering with ACOs to curb fraud, waste, and abuse.
Increase Multi-Payer Contracts
As enrollment in Medicare Advantage continues to grow, roughly 75 percent of ACOs hold contracts with multiple payers but variation in program rules often means that providers must manage to the model rather than the patient.
Congress should seek greater alignment between APMs and Medicare Advantage to ensure that both models provide attractive, sustainable options for innovative care delivery.
Since 2012, ACOs have generated $34 billion in savings and returned $13.5 billion in net savings to the Medicare Trust Fund.
In 2024 alone, ACOs generated $6.5 billion in savings and returned $2.4 billion in net savings to the Medicare Trust Fund.
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