AMGA Calls on Congress to Advance Value-Based Care, Support Providers

Congress should focus on advancing value-based care by investing in proper infrastructure, incentivizing patient engagement, and supporting continuous telehealth coverage, according to the American Medical Group Association (AMGA).

The organization sent a letter to congressional leaders expressing appreciation for their efforts to support healthcare providers throughout the COVID-19 pandemic. However, the letter urged leaders to improve the Medicare program to help boost value-based care delivery.

Medicare reimbursement cuts, workforce shortages, and inflation have led to consistent burdens for providers and patients, AMGA said. These conditions make it difficult for providers to transition to value-based care. Thus, Congress should establish a more sustainable Medicare payment system.

Improving and incentivizing value-based models is a critical step to supporting the shift. AMGA asked Congress to create a more stable Advanced Alternative Payment Model (APM) program to inform providers that federal policymakers back the transition.

The Consolidated Appropriations Act of 2023 extended the Advanced APM incentive payment for an additional year but lowered the rate from 5 percent to 3.5 percent.

AMGA encouraged leaders to invest in essential infrastructure, including technology, care management, leadership, and analytics. In addition, Congress should support funding for programs that provide upfront financial support for value-based contracts.

Offering patients financial rewards, waived co-pays, and definite access to telehealth could help patients become active participants in their healthcare journey and improve their well-being. AMGA suggested that Congress develop and implement strategies to encourage patient engagement.

Improving the Medicare program also requires better end-of-life care, according to AMGA. Congress should increase reimbursement to reflect the time it takes to engage with patients about end-of-life care.

The letter stressed the importance of solidifying telehealth policies introduced during the pandemic.

“Patients have come to expect telehealth services as a standard method of care delivered by their provider. Congress needs to ensure that this service remains available to all patients permanently and that AMGA members can use the technology as part of their innovative delivery models, which promote patient convenience and safety,” AMGA wrote.

Congress has waived Medicare’s telehealth originating site and geographic limitations for another two years and extended the recognition of audio-only payments. However, AMGA emphasized how these policies must continue permanently to allow patients to maintain access to telehealth.

AMGA urged Congress to preserve Medicare Advantage, noting how the program’s payment model prioritizes preventative care and value. The organization recommended Congress consider any proposed Medicare Advantage policy changes and ensure they do not negatively impact patient care.

Addressing health equity issues resulting from social determinants of health barriers and requiring payers to offer providers access to all administrative claims data are also two key steps to supporting the shift to value-based care, AMGA said.

Finally, the letter suggested that congressional leaders remove the coinsurance payment requirement for chronic care management included in the Medicare Physician Fee Schedule (PFS). This would facilitate more comprehensive chronic care management, lead to greater access for patients with long COVID, and improve care coordination for vulnerable populations, according to AMGA.