Top Issues for ACOs to Watch in 2022

2022 is bound to bring a new set of opportunities and challenges for ACOs and value-based care providers, despite lingering effects of the COVID-19 Public Health Emergency (PHE) and other common themes. The Biden administration will have a second year to implement its agenda, which includes expanding accountable care. Important issues confront Congress, which faces November elections and continued work on a large social spending package. As NAACOS stands ready to help members learn and adjust to an ever-changing landscape, below are the top issues for ACOs to watch in 2022. 

Healthcare industry continues to battle COVID-19 PHE
The COVID-19 PHE will carry into its third year in 2022. Even with numerous policy changes to alleviate the negative effects of the pandemic, such as a waiving of shared losses for ACOs and creating waivers around telehealth use, ACOs continue to grapple with the effects of the pandemic and the unpredictable nature of the virus. It’s unclear when the Biden administration will lift the PHE, and NAACOS will continue to monitor decision making and alert members to any extension or the possible end of the PHE. 

New session of Congress begins
Congress picks up in 2022 where it left off last year, and that’s debating the Democrats’ Build Back Better social spending package. Debate around the Build Back Better Act has detracted from a lot of other health care work. Depending on the timing of the PHE’s ending, expect Congress to start more work on making the PHE’s telehealth waivers permanent. With 2022’s mid-term elections, Congress is working under a compressed schedule. 

Biden administration’s to-do list carries over many priorities from 2021
Much of 2021 passed without confirmed leadership at either CMS or the Department of Health and Human Services (HHS). But with a full slate of policymakers in place, the Biden administration can hit the ground running. Of course, managing the pandemic will take a lot of time, but CMS defined goals in 2021 that can now be addressed in earnest. The administration will continue to press its Build Back Better plan, which could involve some Medicare coverage expansion, Affordable Care Act coverage, possible drug pricing controls, among other health and social programs. 

Advanced APM bonus sunsets
A top advocacy priority for NAACOS in 2022 will be to get Congress to extend the 5 percent Advanced APM bonus for those qualifying in certain risk-bearing alternative payment models (APM). Unfortunately, the opportunity to earn these bonuses stops at the end of this year. NAACOS views this incentive as critical to continuing the movement to more value-based care. Our Take Action page allows you to write your members of Congress asking them to support this extension.  

ACOs evaluated under new quality rules
This year will mark the first year ACOs are evaluated under new APM Performance Pathway (APP) quality scoring rules in MSSP. While ACOs will be scored under APP for 2021, the effects of these changes are mitigated by PHE policies in place at that time. NAACOS will continue to advocate for CMS to make needed changes to this new scoring method to ensure quality assessments are fair, reliable, and accurate. NAACOS is also pleased that ACOs are provided with additional time to transition to electronic clinical quality measures (eCQMs) after our advocacy efforts resulted in pushing back the eCQM requirement. An in-depth NAACOS resource on the new quality requirements is available.  

Welcoming a new class of ACOs
For the first time in two years, the ACO community will welcome a new cohort of ACOs into the Shared Savings Program. NAACOS expects a large class since CMS canceled a potential 2021 class, citing the COVID-19 PHE. We are planning more education and resources to help these new ACOs begin their journey in the value-based care world. 

Direct Contracting Model in full swing
Despite not taking new applications to start in the Global and Professional Direct Contracting Model this year, this Center for Medicare and Medicaid Innovation (CMMI) model will grow in 2022 as some Next Generation ACOs and deferred applicants enter the program’s second performance period. The model’s first year just came to a close, so we’re awaiting initial financial results. Also of note, NAACOS expects a new application cycle to start in the model next year, and with it, a number of changes that we’ve been advocating for nearly two years. 

Awaiting new CMMI reforms and models
Liz Fowler starts her second year at the helm of CMMI, which means she’s had time to put the administration’s spin on new and existing models. Fowler paused a number of programs after taking the job last year, including the ACO track of the Community Health Access and Rural Transformation (CHART) Model. NAACOS is closely watching implementation of CMMI’s strategy refresh, which was released last year and sets a goal of having all traditional Medicare beneficiaries into accountable care models by 2030. 

HHS poised for action on health equity
The Biden administration continues to prioritize improving health equity in its programs. It’s not entirely clear what policies will be implemented to address equity, but last year we saw CMS make changes to its ESRD Treatment Choices (ETC) Model, including stratified bonuses and new health equity incentives, to help. NAACOS has developed a suite of policy recommendations, position papers, and other resources to advocate for models, funding, and policies to support ACOs’ work in this area. 

New rules expected on substance abuse data sharing
In March 2020, Congress passed a law that brings privacy protections for substance abuse treatment records more in line with HIPAA, the Health Insurance Portability and Accountability Act of 1996. This was a change long supported by NAACOS to improve care coordination for substance abuse treatment patients. However, HHS has yet to release a proposed rule on the change, which NAACOS expects this year. 

NAACOS enhances education for ACOs
With a new vice president of education, NAACOS is planning a number of offerings — both in-person and virtual — in 2022. This includes an upcoming Winter Bootcamp, Spring and Fall conferences, webinars, resources and more. We encourage members to contact us with any additional areas for education by emailing us at [email protected].