Accountable care, value-based payment should be part of Making America Health Again

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More competition, enhancing patient choice, and reduction of administrative burdens all must be part of the future of the American health care system, according to the National Association of Accountable Care Organizations (NAACOS).

Meanwhile, the administration of President Donald J. Trump should optimize value-based care and alternative payment models to alleviate chronic disease, according to the National Committee for Quality Assurance.

The organizations weighed in this month as Mehmet Oz, MD, MBA, became administrator of the U.S. Centers for Medicare & Medicaid Services (CMS). He oversees the single largest health insurance plan in the nation.

This month he discussed his leadership agenda and the administration’s Make America Healthy Again initiative. Oz said CMS duties include “shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management.”

“For example, CMS operates many programs that can be used to focused on improving holistic health outcomes,” his announcement said.

Now 100 days in, physicians and other health care leaders are waiting to see exactly how that translates into policies and payments for patient care.

Accountable care counts

Emily D. Brower, MBA
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Accountable care models are the largest alternative payment model (APM) in Medicare and in 10 years have saved more than $28 billion for Medicare, said NAACOS President and CEO Emily D. Brower, MBA. In human cost, physicians and other clinicians have outperformed the quality measures of providers in non-value-based payment models, Brower said this month in a letter to Oz. Those effects come from fewer hospitalizations, preventable admissions, and readmissions, Brower said.

Meanwhile, ACOs regularly target waste, fraud and abuse in health care spending, she said.

“Accountable care has been a strong foundation for improving care for patients,” Brower’s letter said. “We believe there is ample opportunity to build on decades of success and drive significant improvement in the cost and quality of care delivered to Medicare beneficiaries.”

To continue, NAACOS called for additional advances in ACO policies:

• Boosting and retaining competition in health care through sustainable accountable care models. The administration of President Donald J. Trump should ensure physicians can remain in the Direct Contracting model (now known as ACO REACH). CMS also should restore benchmark policies and implement benchmarks that do not penalize providers for past successful performance.
• Enhancing patient choice. Patients without a usual source of care do not benefit from ACO models, so more education is needed for them, along with approaches that allow ACOs to treat those patients.
• Freeing providers from regulatory burdens and driving innovation. CMS has aligned ACO reporting with its Merit-Based Incentive Payment System (MIPS), but that plan has increased reporting burdens while removing incentives. That should be reversed.

“We are committed to ensuring that accountable care empowers patients with solutions to manage their health while achieving its goals of high-quality, cost-effective care,” Brower wrote. “NAACOS and its members aim to shift the health care system to one that focuses on prevention, wellness, and chronic disease management.”

Advocating for value-based care

Margaret E. O'Kane
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This month, the National Committee for Quality Assurance (NCQA) also released its recommendations for priorities for the Trump administration and Congress. NCQA oversees the Healthcare Effectiveness Data and Information, known as HEDIS, the most widely used performance measurement tool in health care.

“For 35 years, NCQA has worked to improve health care quality through measurement, transparency, and accountability,” NCQA President Margaret E. O’Kane said in a news release. “We believe that advancements in quality measurement, care integration and interoperability are needed to create a more efficient and accountable health care system and urge the new administration to prioritize innovative care and payment models that align incentives with improved patient outcomes.”

To start, NCQA said the CMS should expand the commitment to ensure all Medicare beneficiaries are in value-based arrangements by 2030. To do so, CMS should:

• Create payment models that prioritize integration through technology and dynamic care plans
• Introduce Medicare Advantage Star Ratings metrics that promote standardized data exchange.
• Prioritize more effective use of patient-generated data, including person reported outcomes measures.

NCQA said the government leaders should use payment programs to drive industry implementation of a digital quality measures reporting system. The administration and Congress also must address the behavioral health crisis with better and more treatment, including for opioid use disorder and substances use disorder.

Changes from the past

ACO and payment model changes would not necessarily be new for the president. During Trump’s first term, CMS in 2018 announced “Pathways to Success,” its plan to overhaul the Medicare Shared Savings Program (MSSP) that was established by the Affordable Care Act and started in 2012.

In 2018, that move was developed based on a study of ACO performance that found 460 of 561 of ACOs in the MSSP did not take on risks for increases in costs. Those ACOs without risk for cost increases ended up increasing Medicare spending in aggregate, said a CMS announcement at the time. Savings were projected to be $2.2 billion over a decade.

More recently, the White House has touted the president’s efforts on two key elements of health care finance: improving price transparency and lowering prescription drug prices.