Fourteen healthcare groups support the Value in Health Care Act
The bill would extend the 5% Advanced APM incentive payments for an additional six years.
Photo: Peter Griffith/Getty Images
AHIP, the American Hospital Association and the American Medical Association are among 14 national health stakeholder groups that are praising the introduction of legislation to accelerate the move to value-based payments and alternative payment models.
The groups sent a letter to Reps. Peter Welch (D-Vt.), Suzan DelBene (D-Wash.), Darin LaHood (R-Ill.), and Brad Wenstrup (R-Ohio) on The Value in Health Care Act they introduced.
The bill increases Medicare Shared Savings rates, updates risk adjustment rules, eliminates the artificial distinction between "high" and "low" revenue ACOs, addresses ACOs' "rural glitch," and restarts the ACO Investment Model, according to the National Association of ACOs and other groups.
The bill also reinforces the shift to value-based care by extending the 5% Advanced APM incentive payments for an additional six years and authorizing a study of the overlap of various Medicare alternative payment models.
The bill also mandates a report by the Government Accountability Office on health outcomes and racial disparities in Medicare patients cared for by ACO participants compared to traditional Medicare and not assigned to any other APM.
"The Value in Health Care Act of 2021 makes a number of important reforms to strengthen Medicare's value-based care models and Accountable Care Organizations to ensure that these models continue to produce high quality care for the Medicare program and its beneficiaries as well as to generate savings for taxpayers," the letter to Congress states.
The letter was signed by AHIP, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, America's Essential Hospitals, AMGA, America's Physician Groups, Association of American Medical Colleges, Federation of American Hospitals, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs and Premier.
WHY THIS MATTERS
Value-based care is seen as one of the best options to control healthcare spending. The 541 ACOs in MSSP in 2019 saved Medicare $1.2 billion.
But the number of ACOs in Medicare has fallen to 477 this year, down from a high of 561 three years ago.
The Value Act seeks to spur the adoption of alternative payment models by making changes to the APM and ACO parameters.
It would increase the percent of shared savings beginner participants receive; modify risk adjustment to better reflect health and other risk variables; remove barriers to participation by eliminating arbitrary program distinctions; modify performance metrics so participants aren't competing against their own successes; provide greater technical support; extend the annual lump sum participation bonus for an additional six years; correct arbitrary thresholds for Advanced APM qualification; and address the overlap in value-based care programs so that APM overlap within markets complement each other rather than cause confusion.
It also sheds light on health equity by directing the GAO to study health outcomes of seniors assigned to ACOs compared to seniors in regular fee-for-service.
THE LARGER TREND
In 2017, an HHS/OIG report found that 98% of ACOs, after participating for three years, met or exceeded quality measures and outperformed regular fee-for-service providers on 81% of quality measures.
However, in 2019, after changes were implemented to the ACO program, fewer providers participated for the first time since its inception in 2012.
In 2019, ACOs participating in Medicare's ACO program achieved their highest annual savings since the program's start in 2012, producing $1.4 billion in net savings.
Since 2012, ACOs have saved Medicare a net $2.5 billion.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
