ACO
REACH MODEL WINS BACKING OF MAYORS
Earlier this month, the African
American Mayors Association passed a resolution encouraging Congress and the Biden administration to
continue to support the ACO REACH Model in order to better support value-based care and
quality improvement in Medicare. Previously this month, the U.S. Conference of Mayors
passed a resolution in support of ACO REACH. The resolutions come as progressive
Democrats in Congress continue to put pressure on the Biden administration to terminate
the model. NAACOS continues to stress the importance of preserving the model to
congressional offices and encourages our ACO members to do so using our Take Action page.
2023
BOARD ELECTION NOMINATIONS DUE BY AUGUST 5
NAACOS is soliciting nominations for its 2023 Board Member Election, which
will open in August. The NAACOS Board of Directors’ purpose is to advance the core
mission of NAACOS, which focuses on fostering the growth of the ACO model of care. Board
members represent a diverse range of ACO interests and help shape NAACOS priorities,
such as supporting ACOs in operational and clinical best practices, advocating on behalf
of ACOs with Congress and the Executive Branch, and educating the public about the value
of accountable care. To be a NAACOS Board Member, candidates must be employed as
executives of NAACOS member ACOs in good standing at all times during the term of
office. Please nominate a candidate for the board. Information needed is
contact information, a two-to-three paragraph description from the nominee, a bio and
two letters of recommendation. The bio and letters of recommendation must be attached as
files. You will need all of these pieces of information to submit the form.
Self-nominations are permitted. If you have any questions, please contact Anna LaFayette.
CMMI
RELEASES SUCCESSOR TO ONCOLOGY CARE MODEL
This week, the new Enhancing Oncology Model was announced by the Center for
Medicare and Medicaid Innovation (CMMI) and will launch July 2023, replacing the Oncology Care Model (OCM) that sunsets at the end of this month.
Unlike OCM, the new five-year model will require downside risk for all participants,
offering two levels of risk, place more emphasis on health equity with a requirement
that participants screen for health-relate social needs, offer an additional $30 per
month for patients dually eligible for Medicare and Medicaid, and require patients
electronically report updates on their status and outcomes.
Like the OCM,
the Enhancing Oncology Model will be multi-payer and offer participants both a
prospective, per-patient bunded payment for triggered episodes and an opportunity for
retrospective performance-based payments based on quality and savings. Participants will
be responsible for patients’ total cost of care during a six-month episode. However, the
monthly prospective payments under the new model are nearly half of OCM — $70 compared
to $160. CMS will set different benchmarks for each of the seven cancer types included
in the new Enhancing Oncology Model.
The new model is being billed by the
Biden-Harris administration as a reignited effort of the Cancer Moonshot. More
information can be found on CMS’s fact sheet, request for
applications, and frequently asked questions document. Dual participation in the
Enhancing Oncology Model is allowed with MSSP and certain other CMMI models.
Applications are due by September 30.
DR.
ASAF BITTON TO KEYNOTE FALL CONFERENCE
Join
us September 7–9, 2022, for the NAACOS Fall Conference at the Marriott Marquis
in Washington, D.C. The agenda will feature leading ACO experts and CMS officials
sharing timely and essential information for ACOs. Our day one lunch plenary, which will
focus on primary care transformation, will feature Asaf Bitton, executive director of
Ariadne Labs, a health systems innovation center at Brigham and Women’s Hospital and the
Harvard T.H. Chan School of Public Health. Breakout topics and chairs have also been added to our agenda
page.
Two pre-conference workshops on Wednesday, September 7 from 1:00 pm
to 5:00 pm can enrich your conference learning. The two workshops will be:
- ACO REACH Compliance and Waivers chaired by Beth Patak, Equality Health
- Preparing for eCQM Reporting chaired by Anna Taylor, MultiCare Connected Care
Register
Early and Save!
Register before July 15 for the in-person conference and receive
a discount of $300 per person. Can’t attend in person? Register for our live webcast before July 15 and receive a
discount of $100 per person.
Exhibitor
and Sponsor opportunities are now available!
The NAACOS Fall Conference
will feature exhibitors with products and services specifically for the accountable care
community. Reserve
your space today!
DOBBS
DECISION ROILS CONGRESS
In the wake of the Supreme Court of the Unites
States (SCOTUS) decision in the Dobbs v. Jackson Women’s Health Organization case on
June 24, Democratic lawmakers are asking majority leadership and the Biden
administration to take decisive action to protect access to reproductive health care in
states that may preclude it via state law. Over the weekend, nearly three dozen Democratic lawmakers wrote to President Biden asking
for “bold action.” Senators Warren (D-WA) and Smith (D-MN) called on President Biden to
declare a public health emergency (PHE) to extend reproductive rights at the federal
level, and the senators relaunched calls to rescind the filibuster to allow a simple
majority vote on federal legislation. On June 27, Secretaries Becerra, Yellen, and Walsh wrote to health insurers
reminding them of legal requirements to cover contraception at no cost. Meanwhile,
bipartisan advocates for telehealth began reviewing what federal and state rules may
affect telehealth-assisted pregnancy terminations via medication and the implications
for now-pending federal legislation to relax telehealth prescribing and reimbursement
requirements post COVID-19 PHE. On the same day that SCOTUS overturned Roe v. Wade via
the Dobbs decision, bipartisan lawmakers passed gun control and mental health
legislation, freeing up the legislative docket for appropriations work and potential
activity on a slimmed-down version of the President’s Build Back Better (BBB) proposal.
It is unclear what path Congress will take given the immediacy of the Dobbs decision and
whether Congress will pivot back to work on BBB or engage in hearings, oversight
investigations, and other activities related to Dobbs. As NAACOS looks towards the
year-end funding bill as a potential vehicle for activity on the Advanced APM
(Alternative Payment Model) bonus extension, the prospect of a continuing resolution due
to a divided and partisan Congress post-Dobbs is something NAACOS is watching closely.
CMS
BLOG DISCUSSES SPECIALTY INTEGRATION IN POPULATION HEALTH MODELS
CMS
recently published a blog article discussing how best to integrate specialty care in
population-based models. These recommendations come after CMS held numerous stakeholder
listening sessions on the topic, including one with NAACOS. Importantly, the article
discusses the importance of aligning incentives between specialists and ACO initiatives
and recognizes the need for CMS to ensure population health incentives are not weakened
where there is overlap. Additionally, the blog emphasizes the need for providing data on
specialist performance and enhancing data sharing across practices to better facilitate
this integration. NAACOS has urged CMS to ensure the agency develops specialty models
and overlap policies that do not harm population health models like ACOs. CMS notes an
increase in the volume of specialty visits for Medicare patients, as well as spending
for these services, underscores the need for effective coordination of primary and
specialty care providers.
NAACOS
COSPONSORS WEBINAR WITH PCC ON MSSP SUCCESS
This week, NAACOS
cosponsored a webinar with the Primary Care Collaborative (PCC) to discuss primary care
strategies that have contributed to success in the MSSP. Moderated by Linda Brady,
Value-Based Care Portfolio and Network Strategy Manager with Boeing Healthcare Strategy
and Well Being, panelists included Dr. Jose Pena, CEO and CMO of RGV ACO Health
Providers, Dr. Sarah Mullins, Regional Medical Director with Aledade, and Dr. Fred
Wallisch, Medical Director of ACO Programs with Caravan Health. Each of these speakers
has a background in primary care and deep knowledge of primary care’s contributions to
successful ACOs. This webinar was a follow-up to a previous event examining evidence from MSSP ACOs and exploring
the role of primary care in successful ACO models. The recording and slides are available. This event is part of the Better Health Now
(BHN) campaign, which is focused on driving policy changes to increase
investment in primary care and promote primary care payment models that ensure all
communities have access to care.
NAACOS
SUBMITS COMMENTS FOR MA OVERSIGHT HEARING
On June 28, the House Energy
and Commerce Oversight and Investigations Subcommittee held an oversight hearing of private sector Medicare Advantage (MA)
plans. The hearing featured witnesses from the Health and Human Services (HHS) Office of
the Inspector General (OIG), Government Accountability Office (GAO), and Medicare
Payment Advisory Commission (MedPAC). The hearing examined the quality of care that
America’s seniors receive through MA and the fiscal sustainability of the program going
forward. NAACOS submitted comments to the committee highlighting how ACOs are an
alternative to MA that have a history of lowering costs and improving quality. It also
calls on the committee to consider the Value in Health Care Act (H.R. 4587) this year to improve the ACO program and extend the 5
percent Advanced APM bonus. Visit NAACOS Take Action to write your lawmakers today to ask them to support
the bill!
NAACOS
UPDATES MEDICAID ACOS PAGE
Last week, NAACOS updated the Medicaid ACOs page
with key details on state Medicaid programs that have implemented or tested ACO or
ACO-like initiatives to serve Medicaid beneficiaries. Given the considerable variability
across states in their Medicaid payment models, accountable care initiatives in Medicaid
programs often look different from traditional Medicare ACO programs. This webpage
includes links to summaries and key resources for each state Medicaid ACO program, with
results when available. Importantly, many state Medicaid ACO models focus on addressing
social drivers of health (SDOH) as a key strategy to improve outcomes for Medicaid
beneficiaries. The new webpage includes several resources on addressing SDOH within ACO
models and broadly through Medicaid initiatives. The Medicaid ACO landscape is
frequently changing and NAACOS will update this webpage as new resources become
available. If you do not see your state included on the page and wish to inform us of
Medicaid ACO efforts or programs in your state, please contact us at [email protected].
MULTIPLE
SCOTUS OPINIONS ISSUED ON HEALTH CARE
While most of the attention
around the Supreme Court went to its abortion-related decisions this week (see above
article on the Dobbs decision), there were several other notable moves for the
healthcare industry. The nation’s highest court ruled that employer-sponsored health
plans can make all dialysis providers out-of-network, making their care so expensive
that they potentially drop their employer’s plan and opt for Medicare, which end-stage
renal disease (ESRD) patients are eligible for. Justices said intent matters when ruling
that prosecutors must prove doctors knowingly prescribed drugs in aberrant ways when
trying to punish doctors for prescribing drugs unlawfully. The matter relates to “pill
mills” and the opioid epidemic. Lastly, the court ruled against hospitals over how CMS
computes Medicare’s disproportionate share hospital adjustments, which is meant to
reflect the steeper cost of care for low-income patients. Hospitals had questioned the
inclusion of certain Medicare patients.
The Supreme Court declined to hear
arguments in a case that MA plans payback payments based on unsupported diagnoses based
on a 2014 CMS rule. Also, justices declined to take up a case debating whether a
pharmacy benefit manager has a fiduciary responsibility to lower drug prices.
NAACOS
LAUNCHES SOCIAL MEDIA CAMPAIGN FOR MEDICARE ANNIVERSARY
This week,
NAACOS is launching a social media campaign to spotlight the 57-year anniversary of
Medicare, which was signed into law by President Lyndon Johnson on July 30, 1965. The
population of beneficiaries served by Medicare has more than tripled in the past five
decades and Medicare spending has grown even more significantly. Earlier this year, the
2022 Medicare Trustees Report projected that the Part A Hospital
Insurance Fund will be insolvent by 2028. We know value-based care models like ACOs save
Medicare money while delivering high-quality care to beneficiaries, which is why we’re
encouraging our members to use their social media channels to highlight the importance
of ACO models in preserving the longevity of Medicare. NAACOS has developed a social media
toolkit with hashtags, draft posts for social media, helpful graphics, and key
messaging points for members to use to spread support for ACOs and value in health care.
You can download the toolkit and share these messages or edit them to
include your own success stories.
CMS
RELEASES PROPOSED HOME HEALTH AND ESRD RULES
On June 17, CMS issued the
calendar year (CY) 2023 Home Health Prospective Payment System proposed rule, which
would update Medicare payment policies and rates for home health agencies (HHAs). CMS
estimates that Medicare payments to HHAs in CY 2023 would decrease in the aggregate by
-4.2 percent, or -$810 million compared to CY 2022. The fact sheet and proposed rule are available. On June 21, CMS issued a proposed
rule to update payment rates and policies under the ESRD Prospective Payment System for
renal dialysis services. For hospital-based ESRD facilities, CMS projects an increase in
total payments of 3.7 percent. For freestanding facilities, CMS projects an increase in
total payments of 3.1 percent. The fact sheet and proposed rule are available.
MEDPAC
SENDS JUNE 2022 REPORT TO CONGRESS
On June 15, MedPAC released its June 2022 Report to Congress. The report covers a range of
Medicare payment issues including chapters on APMs, improving the accuracy of MA
payments, and addressing the cost of Part B drugs. In this report, the commission
provides specific suggestions to operationalize last year’s recommendation that CMS
should reduce the number of APMs in Medicare. The commission outlines suggestions that
include reducing the number of ACO tracks, eliminating the periodic rebasing of ACO
benchmarks, and developing a national episode-based payment model to work concurrently
with ACOs.
NAACOS is pleased to see that MedPAC continues to dedicate
attention to improving the ACO model and APMs. When it comes to better harmonizing
episode-based models with population-based models like ACOs, MedPAC left a lot of detail
up to CMS, opting instead to give some broad, high-level principles that make sure ACOs
are helped not harmed by a new program. While NAACOS has some concerns about how
mandatory episodes would interact with ACOs, we appreciate that MedPAC’s report
emphasized for CMS that allocating savings between models must be done in a way so
incentives for the ACO to save and participate are considered. A NAACOS summary of the June 2022 MedPAC Report is available.
NAACOS
ENDORSES LEGISLATION ON QUALITY MEASURES FUNDING
On June 23, Reps.
Judy Chu (D-CA) and Buddy Carter (R-GA) introduced the Promoting Health Care Quality Act
of 2022 (H.R. 8201). Each year, Congress provides funding to Medicare to
support and strengthen healthcare quality measurements. Unfortunately, these funds were
reduced in last year’s budget by $6 million. This bipartisan legislation restores
previous funding levels to sustain existing quality programs and address national
healthcare quality and patient safety priorities in 2023. With Congress currently
considering fiscal 2023 funding legislation, NAACOS is proud to join the National
Quality Form and others endorsing this important legislation.
CMS
POSTS 2021 MIPS SCORE PREVIEWS
CMS recently posted 2021 score previews
for the Merit-Based Incentive Payment System (MIPS). This preview period will be open
until the final score and resulting payment adjustment amounts are provided, which CMS
anticipates will take place in August. These 2021 scores determine 2023 payment
adjustments. During the preview period, performance category level scores and bonus
points will be available. ACOs can access this preview data by having APM entity
representatives with the security official or staff user roles access the Quality Payment Program (QPP)
portal using your ACO-MS username and password. If you feel there is an error
with your score, or if you have any questions, CMS recommends contacting the QPP Help
Desk at [email protected].
CMS
OUTLINES BUSINESS CASE FOR ADDRESSING HEALTH-RELATED SOCIAL NEEDS
This
month, CMS published a new resource, “Making the Business Case for Addressing Health-Related Social
Needs” (HRSNs) based on lessons learned from the Accountable
Health Community (AHC) Model. The resource spotlights Reading Hospital’s
Community Connections Program (CCP), which was created to implement the AHC Model,
conducting screening, referral, and community service navigation for HRSNs of Medicare
and Medicaid beneficiaries. The CCP focused on demonstrating a return on investment
(ROI) to create buy-in among hospital leaders, identifying avoidable emergency
department (ED) use as the most meaningful metric. In a 12-month period, the CCP was
able to reduce avoidable ED visits by 15 percent, which correlated with an estimated $1
million in savings. In conjunction with the demonstrated cost savings, the CCP team also
developed case studies and patient success stories to convey the importance of
addressing HRSNs. These efforts resulted in hospital leadership agreeing to provide
sustainable funding for the CCP’s HRSNs work. The AHC Model was operated by the CMMI for
a five-year performance period beginning May 1, 2017, to test whether providing support
for service delivery approaches that link beneficiaries with community services to
address HRSNs can affect health care costs and reduce health care utilization. Early findings show the model holds promise for reducing ED use
among Medicare beneficiaries.
HEALTHY
FUTURES TASK FORCE RELEASES PLAN ON DOCTOR-PATIENT RELATIONSHIP
Last
year, House Republicans established the Healthy Futures Task Force to outline a health policy agenda
should the House flip in the upcoming election. On June 21, the Task Force’s
Doctor-Patient Relationship Subcommittee released an outline of principles to improve the relationship
between doctors and patients. The subcommittee outlined the needs to improve quality
metrics, address electronic health record compatibility, provide certainty surrounding
provider reimbursement, and reform prior authorization. NAACOS has been engaging with
the task force and looks forward to working with Members of Congress to support policies
that strengthen Medicare’s value-based care programs.
CMS
BEGINS PAYING 2020 ADVANCED APM BONUS
This week CMS began distributing
bonus payments to clinicians who were Qualifying Advanced APM Participants (QPs) based
on their 2020 performance. Additional information is expected to be available on the QPP
website in the coming days. If your ACO sees something that looks inaccurate, please to
let us know by emailing us at [email protected]
and contacting the QPP Help and Support Center.
The agency will also
begin publishing QP determinations for 2022 performance on the QPP Participation Status
Tool in July after the first snapshot. As a reminder, performance year 2022 is the final
year for providers to qualify for a 5 percent bonus in payment year 2024. NAACOS and our
stakeholder partners are engaging with Congress asking lawmakers to extend these
incentives for six additional years. Contact your member of Congress today to ask them to support an
extension of these critical incentive payments for value-based care providers.
|
