ASK YOUR LAWMAKERS TO EXTEND MEDICARE’S ADVANCED APM INCENTIVE
As Congress begins to debate end-of-year priorities, it’s more important than ever that your Members of Congress hear from their constituents. It’s especially important for them to hear about how ACOs are using advanced Alternative Payment Model (APM) incentives to help improve patient care and offer benefits not covered by Medicare. In October, NAACOS led a sign on letter with 23 other associations and over 600 health care stakeholders calling on Congress to extend Medicare’s advanced APM incentives. Please contact Robert Daley for assistance with talking points and staff contact information. MSSP CHANGES FOR 2024 AND BEYOND
NAACOS is pleased to share its detailed analysis of the Calendar Year (CY) 2024 Medicare Physician Fee schedule final rule. In case you missed it, you can watch the archived webinar on these changes. The final rule included several positive changes for ACOs that NAACOS has been advocating for, including improvements in quality reporting, more fair benchmarking policies, a smooth transition to a new risk adjustment model, keeping advance payments for new ACOs who transition to risk, helping ACOs who serve high-cost beneficiaries, and others.
NAACOS will now focus on advocating for changes that we would like CMS to incorporate in next year’s rulemaking. NAACOS will be advocating for Enhanced+, prospective population-based primary care payment, ensuring Medicare clinical quality measures (CQMs) remain as reporting options for several years, improving benchmarks, and driving more innovation in the program. We want to hear from you on your priorities for model improvement; please send any suggestions to [email protected].
PROPOSED INFORMATION BLOCKING RULE
CMS recently issued a proposed rule implementing provisions of the 21st Century Cures Act to create disincentives for health care providers committing information blocking. CMS proposes that ACOs who are health care providers, as well as ACO providers/suppliers who are engaged in information blocking, would be removed from or denied approval to participate in the MSSP. CMS also proposes separate disincentives for clinicians and hospitals. NAACOS has developed a summary of the proposed rule for members. Comments on these proposals are due on January 2, 2024, and can be submitted at regulations.gov (refer to file code RIN 0955-AA05). Please help inform NAACOS comments by sharing your feedback to [email protected].
NOVEMBER ACO REACH LEARNING DISCUSSION
Join NAACOS for its next ACO REACH Learning Discussion on November 17 at 12:00 pm ET. This month, we’ll spend time on the 2022 performance results. We’ll hear from a few ACOs on what they think drove their success, and we want to hear from others. These monthly calls offer a chance to connect with peers about important topics related to the model. If you’re interested and not already signed up, you can register now.
ALLIANCE FOR VALUE-BASED PATIENT CARE UPDATES
The Alliance for Value-Based Patient Care, of which NAACOS is a founding partner, released multiple pieces recently that highlight the benefits of value-based care on patients.
As part of the Alliance’s efforts, we highlight patient and provider stories that demonstrate how value is working. You can find these stories on our website. Feel free to share them. Please submit stories from your organizations to help bolster this effort. Contact David Pittman to schedule a call to capture your stories. Follow the Alliance on LinkedIn and X.
LAWMAKERS EXTEND GOVERNMENT FUNDING
With government funding scheduled to lapse on Friday, Nov. 17, Congressional leaders rallied lawmakers to support a two-phase short-term funding proposal from House Speaker Mike Johnson (R-LA) that would temporarily extend funding to allow more time to reach an agreement on long-term spending priorities. The proposal includes the following extension timelines: January 19 – Military Construction, Veterans’ benefits, Transportation, Housing, Urban Development, Agriculture, the Food and Drug Administration, Energy and Water programs February 2—Funding for all other federal operations, including Health and Human Services and Defense CONGRESSIONAL COMMITTEES CONSIDER MEDICARE EXTENDERS Lawmakers are working to address a long list of heath care priorities, including extending health programs such as Medicare’s advanced APM incentives. Congressional committees are offering varying approaches to address health care priorities that will be reconciled as each chamber develops its final bills. NAACOS is pleased that the advanced APM incentives remain a part of the discussions. However, the cost of extending the incentives will continue to be our limiting factor. NAACOS will continue to advocate for the highest possible incentive payment for clinicians in advanced APMs.
- Senate Finance Committee— voted unanimously to approve a health care package that includes a one-year 1.75 percent advanced APM extension and threshold freeze, along with a 1.25 percent adjustment to lessen physician payment cuts. During the committee hearing several senators spoke favorably about the benefits of APMs. Although cost restraints limited the committee’s ability to include a larger advanced APM incentive, there was support from committee leaders to work next year to address physician payment issues and continue inventing the movement to value. Other provisions of the package include mental health reforms, pharmacy benefit reforms, and Medicare payment modifications.
- House Energy and Commerce Committee— The health subcommittee approved a bill sponsored by Reps. Kim Schrier (D-WA) and Neal Dunn (R-FL) that includes a one-year 3.5 percent advanced APM extension, threshold freeze, and gradual phase down of incentives based on the number of years a clinician has qualified as a qualifying APM participant (QP). While not ideal, this bipartisan agreement is a significant improvement compared to the discussion draft the committee released last month that included a retroactive five-year cap that would have made most QPs ineligible for bonuses.
MEDICARE ADVANTAGE RULE RELEASED
On November 6, CMS released a proposed rule for policy and technical changes for the Contract Year 2025 Medicare Advantage Program. Key provisions of the proposed rule include:
- Broker compensation. Defining broker compensation as a defined fixed amount that is paid regardless of the plan the beneficiary enrolls in. Additionally, prohibiting volume-based bonuses to marketing “middlemen.”
- Behavioral Health. Updating the network adequacy requirements to include outpatient behavioral health. This is intended to capture marriage and family therapists (MFTs) and mental health counselors (MHCs) who are newly eligible Medicare clinicians beginning January 1, 2024.
- Supplemental Benefits
- Requiring plans to provide a mid-year enrollee notification of unused supplemental benefits. The notification must be personalized to each enrollee, including cost sharing, instructions for accessing the benefit, and network application of the benefit.
- Requiring that bids must demonstrate that supplemental benefits for chronically ill patients have a reasonable expectation for improving health or overall function, as supported by research.
- Utilization Management. Requiring plans to analyze from a health equity lens.
INNOVATION CENTER RELEASES QUARTERLY ACO REACH UPDATE
REACH ACOs combined to reduce Medicare spending by 7.7 percent compared to their benchmarks through the first two quarters of 2023, according to the most recent data released by the CMS Innovation Center. However, CMS notes that spending early in the year is lower because beneficiaries have not yet met their Part B deductible and the model’s retrospective trend adjustment for 2023, estimated to be -2.7 percent for aged and disabled beneficiaries, has not yet been applied. Data on quality performance in early 2023 is largely in line with results from previous quarters. Lastly, the CMS Innovation Center notes 3.2 percent of services were covered by REACH’s capitation payment options. The complete quarterly update is available. BPCI-ADVANCED PARTICIPATION AGREEMENTS DUE DECEMBER 4
Participation Agreements for the Bundled Payments for Care Improvement (BPCI) Advanced model are due on December 4, 2023. This includes the selection of Episode Initiators and Clinical Episode Service Line Group selections. The start of a new model year will begin on January 1, 2024, and the model will conclude on December 31, 2025. The Innovation Center will hold a webinar on November 29 at 2:00 pm ET to answer model questions. Registration is available. The Innovation Center also has a Model Overview Fact Sheet for additional information.
DON’T MISS OUR 2024 BOOT CAMPS – AGENDAS NOW AVAILABLE
Join us February 8-9 at the Marriott Orlando Lakeside for our 2024 Boot Camps: one focusing on data and analytics sponsored by Wakely and a second on best practices for clinical operations sponsored by Brilliant Care and iRhythm. Boot camps will be held concurrently, and 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.
**This boot camp will only be 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.**
Registration Rates:
ACO Member – $1,195 per person
ACO Non-Member – $1,495 per person
ACO Member Group Rate – $5,000 for up to 5 individuals **Mix and match your group rate! Those registered under a group rate do not all need to be going to the same boot camp.**
Register Now!
SPRING 2024 CONFERENCE REGISTRATION NOW OPEN!
Meet us at the Baltimore Hilton Inner Harbor on April 10–12 for the Spring 2024 Conference! The 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 available! Reserve your space today!
WATCH NAACOS’ WEBINAR ON NEW AHEAD MODEL
NAACOS members can dive deeper into the implications for ACOs from the Innovation Center’s latest model, States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD). AHEAD will allow states to establish multi-payer total cost of care models in the form of hospital global budgets and enhanced primary care payments. This model is similar to the Maryland all-payer model. ACOs familiar with operating under that model will share their perspectives on what this model may mean to ACOs in states pursuing AHEAD. The recording is available on-demand. FINAL THREE FALL AFFINITY GROUPS COMING UP ATER THANKSGIVING
Join us for the final three virtual affinity groups on Tuesdays from 3:00 pm to 4:00 pm ET. If you have not already signed up for the following three learning labs, click the links below. If you have previously signed up, use the zoom link you received to join the meeting.
CMO and Clinical Issues
Meets: November 28, 2023, and February 27, July 23 and December 3, 2024, from 3:00 to 4:00 pm ET.
Participants should include CMOs, CNOs, Population Health Officers, and others who manage patient care, and clinical care redesign, etc.
Sign up for the Clinical Affinity Group.
Compliance and Legal Issues
Meets: December 5, 2023, and March 5, July 30, and December 10, 2024, from 3:00 to 4:00 pm ET.
Participants should include ACO leaders and staff members who deal with compliance documentation, operations, or events, as well as those who deal with ACO contracting with payers and participants.
Sign up for the Compliance and Legal Affinity Group.
Executives
Meets: December 12, 2023, and February 20, July 16 and November 19, 2024, from 3:00 to 4:00 pm ET.
Participants should include CEOs, CFOs, Executive Directors, Chief Value Officers, and others who oversee the ACO’s finances, budget, strategy, contracting, etc.
Sign up for the Executive Affinity Group.
VIRTUAL CONFERENCE ON ADVANCING PRIMARY CARE
The second National Primary Care Transformation Summit will be held December 4–7, 2023. This virtual conference (live and archived webcast) brings together health care, government, and policy leaders to discuss key topics and strategies on advancing primary care. NAACOS members, sponsors and partners are represented, including Rob Mechanic and Jen Perloff, PhD, from the Institute for Accountable Care, with panelists Bob Phillips, MD, and Bob Rauner, MD, to discuss advanced primary care within ACOs. The full agenda with all sessions and speakers is now available. Registration is free for primary care providers.
ACOS REPORT STRONG GROWTH IN VALUE-BASED CONTRACTING
A paper published last week in the American Journal of Managed Care shows strong growth in commercial, Medicare Advantage, and other value-based contracts by organizations participating in Medicare ACO programs. It also reports substantial growth in contracts with downside risk. The study is based on survey data provided by NAACOS members. You can read the paper on the journal’s website or download a copy.
LEARNING LAB RECORDINGS AND MATERIALS AVAILABLE
Have you missed previous Medicaid or annual wellness visit (AWV) Learning Lab sessions? Then we have good news! These sessions have been recorded, and along with materials they can be found on the NAACOS website under the Education and Events tab. Any NAACOS member with access to our website can login and access. If you know individuals who are part of your member organization that would benefit from this information and do not have access to our website, they may request access by clicking through the Member Login box on the homepage or request directly. Our next AWV Learning Lab is today, November 16, at 2:00 pm ET, and our final Medicaid Learning Lab is December 1 at 2:00 pm ET. Sign up today using these links if you have not already done so.
| WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE |
- A survey from the Institute for Accountable Care shows value-based care contracting is picking up across all lines of payers with Medicare ACOs leading the way.
- The latest blog from NAACOS showcases what some of the most successful ACOs think is driving their savings.
- Family physicians operating in value-based care models report less burnout, according to a new survey from Elation Health and the American Academy of Family Physicians.
- HHS leadership provides an update on the Initiative to Strengthen Primary Care in this National Academy of Medicine commentary, highlighting key changes for primary care in the 2024 MPFS rule and a recent issue brief detailing the department’s actions to support primary care.
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