NAACOS, AMA Push for Long-Term Value-Based Care Efforts

Twelve healthcare organizations, including the National Association of ACOs (NAACOS) and the American Medical Association (AMA), have urged congressional leaders to engage with stakeholders and consider long-term approaches for furthering value-based care.

The organizations sent a letter to Sens. Ron Wyden and Mike Crapo, the top Democrat and Republican on the Senate Finance Committee; Reps. Cath McMorris Rodgers and Frank Pallone, leaders of the House Energy and Commerce Committee; and Reps. Jason Smith and Richard Neal, leaders of the House Ways and Means Committee.

Certain efforts, including extending the advanced alternative payment model (APM) incentive payment for an additional 12 months, have helped support value-based care adoption. However, as leaders consider their priorities for the 118th Congress, they should assess more long-term approaches.

Specifically, Congress should extend value-based care incentives to help attract physicians to participate in advanced APMs and reward those who continue in the models. In addition, CMS should be given the authority to adjust qualifying thresholds through rulemaking and set varying thresholds on some models to ensure they are attainable for all participants.

The organizations highlighted the importance of removing barriers to APM participation, as these models can help improve care coordination delivery. Eliminating distinctions that penalize safety-net providers and improving financial methodologies would help facilitate participation. Reducing regulatory burdens with flexibilities and waivers for clinicians moving to risk would also help advance value-based participation, the groups wrote.

The letter asked the lawmakers to provide a broader pathway for more clinician types to engage in APMs. Congress should work with the CMS Innovation Center and direct CMS to redesign its evaluation strategies to isolate specific innovations while controlling for other variables.

Congress should also broaden the criteria by which the Innovation Center models qualify for Phase 2 expansion and direct the Center to engage stakeholder perspectives during APM development.

Additionally, the groups urged leaders to establish parity between APM and Medicare Advantage program requirements. Aligning the two care models could help ensure they both provide sustainable options for providers to shift to value-based care delivery. Alignment could also ensure APMs do not face a competitive disadvantage.

Congress should encourage more multi-payer value-based arrangements and examine how APM incentive payments and shared savings payments are passed on to physicians.

The organizations highlighted how value-based payment reforms have generated over $17 billion in gross savings for Medicare over the last decade. More than 13 million Medicare beneficiaries receive care through an accountable care organization, and nearly 573,000 physicians and other non-physicians participate in the Medicare Shared Savings Program.

Around 30 percent of Medicare clinicians participate in risk-based payment models, but the organizations noted that there is a significant opportunity for this rate to grow.