By Casey Korba, Director of Policy
Health Care Value Week provided an opportunity for Aledade and our fellow travelers in value- based and accountable care to kick off 2022 with clear and consistent messaging around the ability for value-based care (VBC) models to improve quality of care and patient experience, address health inequities, and lower costs. Value Week gave us a chance to celebrate the progress made in value-based care to date and to chart a path forward on key legislative and regulatory priorities through meaningful dialogue with health care executives and policymakers in the Administration and Congress.
Aledade and our stakeholder partners drove three core messages throughout the week in our discussions:
- Continually refining the models will encourage participation and success. The last decade of clinician experience in implementing value-based models has shown getting the benchmark and risk adjustment methodology right is critical to ensuring participation, improve health outcomes, and drive savings. We know that the “rural glitch” penalizes some practices for excellent performance compared to those with poorer performance, particularly in rural communities that have market share. And we know that to advance health equity, we need to ensure clear glide paths for those practices who serve vulnerable, hard-to-reach populations.
- Having the right incentives in place sends a critical signal that the shift to value is inevitable. Aledade and other stakeholders shared how being in accountable care models has provided the investment needed to keep practices up and running through the darkest days of the pandemic, as well as have the data and infrastructure to help patients manage chronic conditions, and stay out of the emergency department and hospital. In immediate terms, that means extending the 5% Advanced Alternative Payment Model (AAPM) bonus to encourage more practices to join. It also means getting clear signals from the Administration and Congress on the inevitably of VBC and the shift away from a system that rewards volume.
- Advancing equity requires expanding value-based care in underserved communities. The learnings from the pandemic have shone a harsh light on just how far the health care system needs to go to achieve health equity. Value Week participants shared compelling stories of how being in accountable care models has enabled them to address patients’ social needs, through connecting them to community resources and investing in community health workers and team-based care, which is not possible in a solely fee-for-service (FFS) structure that pays for the volume of services.
Members of Aledade’s leadership team participated in three sessions over the course of the event. Summaries, as well as recordings of the sessions, are available below for those who were unable to attend. (Click the hyperlink to jump to the corresponding session summary.)
- CMS Medicare Reform Updates (Interview with Meena Seshamani, Director of the Center for Medicare)
- Roundtable on the Implications for the Future of Primary Care
- Incenting Value: How Congress Can Accelerate Health Care Innovation
CMS Leadership took the opportunity to share the strategy and vision that will guide the agency in the coming years
CMS leadership have been clear on their goal to have 100% of beneficiaries in accountable care relationships by 2030. To meet this goal, leaders are focusing on helping beneficiaries understand the value of being in accountable care models, ensuring underserved communities and populations that to date have not been served in these models have access to them, and taking a fresh approach to measuring the models. For example, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation Liz Fowler discussed that while a model’s ability to generate savings will remain important, the impact the model has on care delivery, care transformation, and reduction in administrative burden will also factor into the evaluation.
Aledade’s Chief Commercial Officer and Chief Policy Officer Sean Cavanaugh had the opportunity to interview Meena Seshamani, Director of the Center for Medicare. Seshamani spoke about how she saw the positive impact Medicare could have on patients’ lives during her years practicing medicine. Cavanaugh noted that addressing health equity is entirely consistent with value-based care models. Seshamani agreed and provided examples of how the pandemic illustrated ACOs’ ability to provide high-quality care in the home and help patients address their social needs. She discussed the agency’s plans to better align models based on learnings from the Medicare Shared Savings Program. She also emphasized the importance of hosting more listening sessions and the agency’s desire to hear from beneficiaries, clinicians, and multiple stakeholders to learn what is important to people and communities, and how to better improve the experience of value-based care.
Dora Hughes, the Chief Medical Officer at the CMS Innovation Center, spoke about how CMMI is embedding equity into models, both new and existing. In particular, she discussed how CMMI was leveraging data and expertise across all of the Department of Health and Human Services to identify proxies that make sense where there are significant data gaps, exploring strategies to share best practice among model participants, and leveraging data from earlier work in the Accountable Health Communities Model that began in 2016.
Daniel Tsai, Director of Center for Medicaid and CHIP Services, spoke about how his team was working with different stakeholders to make progress in value-based care and advance the agency’s equity goals. He acknowledged that each state is different in their approach and requires flexibility. He spoke about the importance of meeting each state where they are, and making room for dialogue and partnerships. Some of the challenges his office is working to overcome are how to better integrate behavioral and physical health and getting to better care coordination.
Aledade co-founder and CEO Farzad Mostashari on the future of primary care
Mostashari participated in a panel with leadership from the American Academy of Family Physicians, Agilon, and Iora Health. When the panel was asked what is needed from the Administration and Congress to maximize primary care, Mostashari thought it was a sense of inevitability. He spoke about his time leading the Office of the National Coordinator for Health Information Technology, and how getting 90% of practices to transition from paper to electronic medical records (EMRs) was not large penalties or incentives, but the sense of inevitability that EMRs were the way of the future.
Other panelists discussed the need to align all payers around value-based care, creating more incentives for smaller practices and for practices serving vulnerable populations to join MSSP and the other models coming out of CMMI.
When each panelist was asked what they would do if they were the CMS administrator, Mostashari said he would lay down “a number and a date” for when practices and health systems had to make the shift to VBC and accountable care and then work backwards from there to determine what needed to be done to get increase participation in these models. Other panelists mentioned setting more aggressive goals for getting all beneficiaries into accountable care models–even as soon as three years–as well as exploring ways to provide technical assistance and capacity-building for less experienced practices. Panelists also mentioned improving communication with beneficiaries around value-based care, working with patients to learn what they wanted from primary care, better coordination with specialty care, and refining and simplifying model methodology.
Value-based care champions in Congress addressed stakeholders in briefing on incentivizing value
Senator Bill Cassidy (R-LA) and Representative Del Bene (D-WA) kicked off the briefing explaining why they were supportive of the shift from FFS to VBC. Senator Cassidy, a former practicing physician, stressed that if the system were to cut reimbursements to primary care, it would lead to having physicians less able to manage patient care and shifting more care to specialists, which causes fragmented care and drives up costs. Rep. Del Bene indicated her support of the Value in Health Care Act, bipartisan legislation she sponsors that would facilitate this shift to VBC by reinstating the 5% bonus to AAPMs and fix the “rural glitch.”
Panelists from organizations that are implementing accountable care models around the country, including Aledade’s deputy chief medical officer Susan Huang, had the opportunity to share what VBC arrangements have allowed them to do, the challenges they face, and why reinstating the AAPM bonus is critical.
The panelists agreed that revenue from VBC has enabled:
- Investments in the analytics tools they need as well as the staff required to get actionable insights from the data.
- Investments in multi-specialty care teams, including at the PC level, specialists level, and extended care such as social workers, care managers, and pharmacists.
- Investments in better care coordination for patients leaving the hospital, which has directly translated to lower readmissions.
- Infrastructure to improve uptake on Annual Wellness Visits in Medicare, which is the “secret sauce” to health and has led to better control of diabetes, obesity, and fewer ED visits
- Data tools that clearly show where there are gaps in care, enabling them to take a more proactive approach to outreach and overall have a more holistic view of their patients.
Dr. Huang discussed a study on Aledade’s 2016 ACO cohort, which showed compelling data on the ability of physician-led ACOs to prevent hospitalizations, improve recommended preventive care and screenings, enhance care transitions, and perform AWVs.
When discussing the challenges that impede VBC, panelists discussed the vast gap between the data they get from CMS and the data they get from their health plan partners. The data from CMS is timely and actionable, and enables them to drill down on where they need to improve outreach. Data lags in the commercial market can make it harder to act quickly and pivot. Full transparency in the total cost of care from commercial health plans are critical for physician practices and health systems to be able to manage care and costs.
From the federal side, panelists emphasized the importance of continuity from CMS and Congress, noting that practices and health systems are investing heavily, and they want to make sure there is a long-term commitment to value, population health, and prevention. The panelists advocated for the extension of the AAPM bonus, citing the need for continual and consistent investments in workforce, data analytics, and programs to better tackle the social drivers of health and provide for upstream care and services. Reinstating the bonus would allow for innovation in population health and prevention, and would lead to better quality outcomes, care delivery, and reduced spending in the long run.
View the full session recording here.
Wrapping up: CMS, congressional representatives, and stakeholders came together to offer a roadmap for 2022
In the last several months, CMS has sent clear signals around their strategy and their need for input and feedback from patients, clinicians, states, and health care stakeholders. We expect more listening sessions and more communications from CMS around new models. Stakeholders have been clear that they are ready to participate and share data and learnings. Health care professionals and organizations have emphasized their need for continuous and consistent messaging, upfront capital, timely and transparent data from all payers, and model refinements that are fair, remove complexity and administrative burden.
At Aledade, we are grateful for the opportunity to participate in the dialogue with health care stakeholders, policymakers, and CMS leadership to set a clear roadmap for 2022. Value Week was a great way to start off the year, and we will continue to use our data and experiences to contribute to learnings and scaling up of value-based and physician-led accountable care.